Let the Real Healthcare Debate Begin!

Expanding healthcare may be the most humane decision but at what cost to deficit, private businesses?

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Wow. Health reform has gotten really interesting. Major changes are occurring almost daily as the Senate searches for a proposal that will get 60 votes. OK, we will drop the public option plan but we're adding Medicare for people aged 55 to 64. The plan will not add to the deficit, the Congressional Budget Office says. Yes, it will, argue experts within the U.S. Centers for Medicare & Medicaid Services. Last summer's alliances certainly seem to be ancient history. Doctors, hospitals, insurers, drug companies, and other players are getting on and off the bandwagon, as elements of their membership splinter off to take contrary positions.

[See Best Affordable Places to Retire.] Of course, watching this maneuvering is scaring me to death at the same time. Lots of Congressmen have stressed that this is the most important legislative issue they will ever confront. If that's so, how can they switch so suddenly among different approaches? And look what strange bedfellows this convoluted process has produced. AARP finds itself advocating and defending cuts in Medicare spending. The Republicans momentarily shed the mantle of fiscal responsibility, unsuccessfully push to restore Medicare spending cuts, and then return to denouncing the Obama folks for record deficits. Follow that logic for me, will you?

Meanwhile, it might help to relieve your anxiety to recall that most of the reform measure, should it pass, will not take effect for years. And who's to say proposals won't be re-legislated before those effective dates? Who's to say even how some of the measures will translate into policy? Health and Human Services Secretary Kathleen Sebelius would have major authority to shape policies and programs. And it will take all the lead time she has to get ready for these changes. Assuming there is a second term for the Obama Administration.

What is clear is that the government seems headed for a much, much bigger role in healthcare. Now, to be honest, the government already has a huge say in just about every meaningful aspect of our healthcare system. It approves and regulates prescription drugs. Medicare and Medicaid are the tails that truly do wag the healthcare dog. These programs dominate pricing decisions in hospitals, doctors' offices and pharmaceutical companies. So, the notion that the current healthcare proposal amounts to a wholesale dismantling of the private enterprise system is not credible.

But as we move along a continuum, from laissez-faire capitalism at one end to government control at the other, there's no doubt that this health reform measure does represent a significant movement away from the private sector. Most industrial countries long ago made this move, but then their citizens have long been more accepting of government control than have Americans. We didn't trust government 200 years ago and we don't trust it much today. Free enterprise had its problems but it produced such great wealth for so many people that we overlooked the flaws. Only now, it seems all those golden eggs produced by our business system have gone into a very small number of nests, most of which are near Wall Street. In short, we no longer trust private companies and the brand of free enterprise they practice.

[See Best Places to Retire.]

U.S. companies are trying to create a compelling argument for not turning over more control of healthcare to government. But the private sector has lost so much stature due to Wall Street scandals and tales of greed that even its good ideas fall largely on deaf ears. So the government moves, with little opposition, to curb executive pay. The feds are even floating the idea of giving shareholders the formal ability to issue a vote of no confidence on executive pay levels. Is this a sensible entitlement for buying a share of stock? Sort of makes you long for the good old days, when the CEO made only 50 times as much as his company's lowest-paid employee.

Where will the pendulum stop?