THE FUTURE OF HEALTH CARE

For several years, the U.S. comptroller general, David Walker, has been warning that the combination of the interest on the federal debt and the rising costs of entitlement programs will soon far exceed projected tax revenues, endangering essential programs and substantially raising taxes. He has largely been ignored by the public – the problem he describes sounds like the sort of big government issue that is endlessly feared but never arrives.

Recently, his agency, the Government Accountability Office, made the issue more personal by convening a forum on health care, its costs and what it means for Americans. Along with having the most expensive system in the world and mediocre scores on health measures such as infant mortality and average life expectancy, said Mr. Walker, “Medicare and Medicaid spending threaten to consume an untenable share of the national economy in the coming decades.” That is, the nation can steeply raise taxes, dramatically cut care – or find a better health care system.

The GAO exercise was useful because it backed away from the typical ideological fight over how to fund health care, and asked a variety of business leaders, public employees and health care experts what role government should have in health care and what an improved system should look like.

Overwhelmingly, participants thought ensuring access to coverage should be a government responsibility and that individuals should be encouraged to assume more personal responsibility for their health and wellness. More than 80 percent believed the federal government should lead in developing measures to judge the system’s outcomes and performance.

Countless politicians have drawn the connection between the precariousness of government budgets and the nation’s current inefficient, expensive health care system. What happens after observation usually is a demand for a particular plan – whether universal coverage or health-savings accounts – that would save the nation if only the plan’s opponents would submit.

But they haven’t in the half-century the topic has been debated, as costs and the number of uninsured Americans continue to rise and news stories on unnecessary medical tests compete with those about the lack of care. What the GAO forum showed was that lawmakers have a chance to agree on broad, incremental changes that could substantially improve paying for care and care itself over time.

For instance, Congress could agree that the federal government has the central role in providing access to affordable coverage, encouraging competitive insurance markets where possible and providing public coverage where those markets do not or are not likely to develop. It could establish both independently developed performance standards for care and for what constitutes personal responsibility, providing incentives for those who follow the guidelines. It could make comparative health care payment levels for the rest of the developed world widely available to begin to restrain costs.

No single ideology is going to win the health care fight; it’s beyond time for Congress to agree on the politically possible and stop waiting for opponents to quit while the health system grows less and less effective for more and more Americans.