With the final debate limited to matters of foreign policy and defense, we can close the book on direct discussion of health care policy. Pretty much all we got was a brief discussion of Medicaid in the first debate, a line about the Obamacare "cut" of $716 billion, and a line tonight about George Bush not proposing to replace Medicare with a voucher. These issues affect how millions of us will leave the world (about two thirds of Medicaid spending pays for the elderly and/or disabled). But we were deprived of detailed explorations of the topic so we could spend more time with the candidates trying to talk over the moderator or discuss who loves their wives more.
Overall a good night for Obama, though no big punches either way. Obama's best moment was when he asked Romney if he would support a business deal which wouldn't share the details about how it would work until after approval for the deal was given. Obama probably continues to gain a bit of the ground he lost after the first debate.
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Unfortunately, and I fear that I will offend the good doctor with this, we will never get a reasonable discussion of healthcare policy in this country because the medical-industrial complex will never allow it.
Our current policies amount to a two-step dance of disfunctionality:
1. We subsidize people's unhealthy behavior, generally by mandating that all guns be legal at all times and by subsidizing certain crops, thereby distorting our national nutrition.
2. We write a blank check to the nation's doctors to "fix" all of these problems, costs be damned.
If I was a doctor, I wouldn't want a bit of this to change, particularly if I was a highly-compensated specialist. The days of the doctor living in the neighborhood and making house calls are long gone. Anymore, the affluent neighborhoods of essentially every mid-sized American city are filled with either Doctors or those who sell supplies to doctors, i.e. pharmaceutical and equipment reps.
There is simply too much money being made from the current system to contemplate reform. Never mind that we spend twice as much, as a % of GDP, as every other industrialized nation and get nothing for it. Never mind that middle-class wages have stagnated over the course of the past generation, largely due to exploding healthcare costs. Never mind that economic mobility is disappearing. Never mind that our national debt is exploding.
We made some policy decisions between 1930-1975, and those served "the Greatest Generation" rather well. However, they are unsustainable and need to be reformed.
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