Health Care Reform on Trial

Sounds like at least one challenge to health care reform will go through. A federal judge refused to block Virginia's challenge to the new law.

I have two reactions to this. First, I agree with the judge. This does need to go to court so people's concerns and grievances can be aired. There's no avoiding that and the administration wouldn't be doing itself any favors if it made a serious effort to block these challenges (I don't know a lot about its efforts to do so, with 21 lawsuits pending and my relatively scant knowledge of the law I don't see the initial challenges to these suits as being evidence the administration didn't see the inevitability of the court challenge and was simply going through basic procedural motions with these blocks).

My second reaction is that if by some means Virginia wins (from what I know I think this is highly unlikely) we're screwed. I think the best evidence is that universal coverage is a necessary but insufficient component of cost control. Without it, there is no way to line up the relevant interests so that their best strategy isn't to simply attempt to pass on costs to someone else rather than dealing with cost inflation directly.

This view seems to be fairly well supported by everything I was reading by health care policy specialists and economists as well as most more general economists. It's well supported by historical and comparative data as well as most modeling.

The counter argument seemed very weak, largely reliant on analogy as well as some theoretical modeling, most of it by general economists, not ones that specialized in health care. I always tend to trust whoever has the best arguments supported by multiple prospective theories and sources of evidence, that leads me to a pro-reform position. The anti-reform position relied too much on a narrow range of perspectives for me to feel it had any real weight.

We'll see what happens but if it is successfully challenged I expect another 40 years of costs diverging from the rest of the world. We can't afford this. Even if critics are right and this is in some way un-American (I don't know any definition of what makes us American that would make sense here but I hear it expressed rather frequently) the preponderance of evidence seems so strong that we're just going to have to swallow this one if we want to remain solvent. As much as we might wish it were otherwise, the nature of the system demands that universal coverage precede cost control, not vice-versa. This does of course mean that we still need a follow up bill for cost control, and we need this urgently since this reform plan got gutted during compromises to pass it.