The Economy of Inertia
The Washington Post’s Ezra Klein hits the nail on the head today regarding the toughest hurdle Democrats face in passing health reform this year: Namely, the inertial force of the medical-industrial complex that’s been built up around the inefficient health system that’s in place.
The central problem in health-care reform is that good policy and good politics point in opposite directions. Good policy proceeds from the understanding that our health-care system is a fractured, pricey, inefficient mess. Good politics, however, proceeds from the insight that a lot of people rely on this fractured, pricey, inefficient mess and don’t trust Washington to change it. Good politics means, as Barack Obama frequently says, that if you like what you have, you get to keep it. But put those imperatives together and you have a strange problem indeed: How do you reform a system that you’re not allowed to change?
It’s an argument that’s perfectly applicable to almost every reform effort lawmakers tackle. That is, even if some industry, or project, or siphon of federal spending is utterly frivolous — even if it’s utterly pernicious — it’s still likely that livelihoods depend on it, and therefore someone in Congress is going to defend it. (For recent examples, look no further than the F-22 fighter jet, or the presidential helicopter, or the push to force the automakers to keep dealerships around even if they’re not selling cars).
Still, the medical industry presents a special case, if only because it’s so enormous (projected to hit $2.6 trillion this year) and because it’s had so many decades to become entrenched. Indeed, any reform efforts will have to receive at least the partial blessing of the nation’s doctors, nurses, hospitals, drug makers, insurers, medical device makers, clinical labs, nursing homes, pharmacists and home-care specialists — not to mention the patient advocates and state governors.
And while the effects of canceling the presidential helicopter are limited largely to one district in New York, every lawmaker in the country has the pressure to keep doctors, hospitals and patients happy. In light of all of this, the wonder is not that the Democrats have been forced to delay their health reform votes, it’s that they’ve been able to get as far as they have.