Health Care – What Works or Just the Same Old Ideas

The Law of Unintended Consequences is probably the only law you can be certain will work in Washington. Sometimes, though not too often, the unintended consequences even turn out for the better.

An example may be the new drug plan for seniors, Medicare Part D. When it was passed, it seemed like a huge boondoggle, more expensive than the country could afford, likely to cost more than was projected, and not providing the coverage seniors really wanted. But it has not turned out that way. Seniors like the program, and it is costing less than was estimated.

With the rising cost of health care and the large number of people without insurance being such big issues this year, maybe it was a good thing the Republicans passed Part D in 2003. What we have had, though we did not intend it, is a test drive of a way to provide health care to everyone.

We can see what single-payer systems can result in by looking at places like England and Canada (or at least we can if we are willing to look). What the new Medicare Part D has given us is a test of a program that provides health care in a different way. Instead of government providing it directly, seniors have been given the chance to pick their own drug plan from a large number of choices provided by private companies. While it was a little rough at first, it has worked.

The success of Part D shows us the kind of program that might be able to work for all health care. It would not be exactly the same, of course, but the Part D provides us an outline of what can work and the experience to make it work even better.

Now the question is whether the people in Washington will look at the experience we had with Part D and learn from it. Will they take a program that has actually worked and use it as a model to go forward or are they just going to go with the same old solutions they always suggest?

In New Zealand in the early 1980s, the National Party government (National was, in theory, the more conservative party) imposed so many controls on the economy that New Zealand had the most controlled economy outside of the East Bloc. As things got worse, the Prime Minister just kept adding more and more controls – and it did not work.

In 1984 the Labour Party won a snap election. The new Labour ministers coming into office did not have much experience. (Labour had been out of office for nine years and had been in power for only six of the previous 35 years.) Most of them were from the post-World War II generation, and they were willing to try new ideas and new ways of doing things. As Roger Douglas, the Finance Minister, said, they had the traditional Labour goals of helping the working people, but they were willing to try new things to do that. They were more concerned about what would work than just doing things the old-fashioned way. Within six years, New Zealand went from one of the most controlled economies in the world to one of the most free because that was what they thought would work. The transition was rough, but it did work, and it worked because the people in government focused on actually getting results, not following out-dated policies.

Will this happen in Washington? Will the Democrats learn from the success of Part D when they make their proposals for health care? So far, the signs are not good. Instead of being happy with how much better Part D has been than expected, the Democratic leaders are talking about how they need to get the federal government more involved to "improve" it.

I do not have a snappy conclusion to this post. I wish the Democratic leaders would learn, but it is probably too late to teach them anything new. All we can do is to continue to fight for works in the hope that newer people will care more about getting results than just following old ideas.