Healthcare: A Complicated Bill Doesn't Make it Bad

In the Spring of 1996, I took Tobe Berkowitz's famous political communications class at Boston University. We studied the populist campaign of Steve Forbes, who won the Republican primary in New Hampshire in February of that year. Forbes signature proposal was the flat tax. He advocated tossing out the current tax code and replacing it with one tax rate for all Americans. He showed off his idea by carrying a post card that would become the new tax return. The idea resonated with legions of frustrated voters put off by the complicated nature of government, which was astonishing. Forbes' idea would raise taxes for the vast majority of Americans who benefited from the graduated tax rate system. It would reduce what is paid by the wealthiest citizens.

Yet, Steve Forbes idea resonated because people could understand it. The lesson learned: Simple sells, even if the idea doesn't benefit the consumer.

Today, the government is having the exact opposite problem. President Obama is pressing for a massive, complicated health care bill that no one really understands. It includes numerous programs for the various groups affected by health care---drug companies, insurance agencies, doctors and patients.

The bill is so complicated, that the general voter's innate mistrust of government causes them to simply oppose it without even trying to understand it. Friends tell me the Massachusetts election of Scott Brown last week really was a referendum on President Obama's plan. The verdict? Since I can't understand it, the bill must be trying to take advantage of me.

Certainly that is not true. The health care bill is not perfect, but it is a step in the right direction. Scott Brown was prone to say during the waning weeks of his campaign that the health care debate in many ways is about fairness: We have health care in Massachusetts; why do we have to pay (via taxes) for the rest of the country to also have health care?

In reality, Senator Brown, the inverse of your argument is true. We have the requirement of universal health care in Massachusetts, and yet, we suffer from the lack of industry cost controls. We are now required to pay for a system with costs that are spiraling out of control. The bills in Congress seek to control these costs; on paper they would reduce health care costs over a ten-year period.

Health care reform in D.C. was in many ways modeled after the Massachusetts program. In addition, it adds a few elements of reform that do not currently exist in Massachusetts. It prohibits denial of coverage for pre-existing conditions. It prohibits insurance companies from denying coverage when patients get very sick. These elements do not help control costs, however. And that's where the bill gets complicated, since no industry wants the government to restrict their growth.

The great majority of people in the United States have health care and like it. A lot of those people have a health care plan provided by the government (medicare or a program provided to veterans). Yet, health care reform is needed badly because health care costs are out of control.

The health care reform bill is very complicated. Since there is some sense of transparency when legislation is created and passed, the American people are tired of how this piece of sausage is being made. The public's support of health care reform has fallen as the debate has ensued, probably because citizens are just sick of talking about it. They don't understand the bill at all, and they don't trust the process. That's a shame, since the legislation could do much to help health care as a whole. Even for voters in Massachusetts.