Rhetoric vs. reality

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Health care reform in America deserves a serious, adult conversation, but we're getting more small talk than straight talk. At one level the debate sounds broad and robust — lots of lofty, feel-good, phrases like universal coverage and comprehensive reform. But these are only campaign slogans. In today's political environment, health care risks becoming another "Obama-drama" — inspiring words with little link to reality that could leave America bitter and disappointed.

Improving our health care won't happen with one stroke of the presidential signing pen; it won't happen by government fiat alone; and it certainly won't happen with populist speeches about reining in "special interests" (also known as doctors, community hospitals, medical schools, and cancer researchers) — the very people responsible for the infrastructure of American health care.

Progress in this critical public-policy area requires several significant steps — maybe not taken all at once — and it demands more citizen education, consumer transparency, cost containment and personal responsibility, not just bigger government programs.

But Democratic presidential candidates debate health care like a duet that belts out only one note. And they sang a similar refrain in Tuesday night's Ohio debate. For Sens. Hillary Clinton and Barack Obama, it's all about the uninsured. Indeed, the dispute about whose plan covers more people is one of the few differences between the two candidates at every debate. Yet promises of universal coverage won't solve the problems that ail American health care. In fact, if done the wrong way, it might make the patient sicker by adding billions in new spending.

The real problem is health care costs — a dimension of the issue that Sen. John McCain emphasizes a lot more than do Mr. Obama and Mrs. Clinton. A new government estimate reported this week by the Wall Street Journal agrees with Mr. McCain. "Government spending on health care could nearly double by 2017 to more than $2 trillion," the newspaper reported Tuesday. And while lowering the number of uninsured could contribute to reducing prices, both Democratic candidates underemphasize — or completely ignore — many other cost drivers essential to effective health care reform. But don't blame just the candidates. The media deserves culpability for the way it covers the health care reform debate — it helps choreograph the Obama-drama. With a few exceptions, most reporters unintentionally fuse "health care reform" and "covering the uninsured."

A candidate lacking a universal coverage plan is like a player showing up to the Super Bowl without a helmet. A senior Republican strategist agreed: "The first question out of most reporters' mouths is: 'What's your plan for universal coverage?' And if you don't have one, you don't have a health care plan. We spend too much time in the health care debate talking about how to pay for it and not enough asking what you get for it." Candidates need to debate a broader menu of health care reforms beyond just how to cover the uninsured. But the media's preoccupation with the universal-coverage fight limits the dialogue.

Medical malpractice law modification is one example. Neither Democratic candidate discusses this policy change because it gets them into hot water with the trial lawyers who bankroll their campaigns. Yet transformations in tort law could save patients money and provide more access to needed medical specialists.

To his credit, Mr. McCain calls for medical liability reform as part of his health care plan. He also focuses on other key elements of change, including controlling costs, reforming the tax system to eliminate the bias toward employer-sponsored insurance, making coverage more portable between jobs, and personal responsibility.

These are not easy choices or simple changes. They are as much cultural as legislative. Getting Americans more involved and educated in health care decision-making requires a large dose of patience, involves several changes in federal law and a reorientation about how we think about this issue — including more emphasis on citizen responsibility when it comes to prevention, managing chronic diseases and becoming smarter consumers. Asking Americans to make changes in their lifestyles and spend time learning the intricacies of the new world of health care does not lend itself to the feel-good, want-change-now Obama-drama. And adding another $70-$100 billion in spending per year to subsidize "universal coverage" when costs are already spiraling out of control is another inconvenient truth that both Democrats fail to address.

Perhaps the media will start listening more to Mr. McCain's health care plan. It includes more of the straight talk real reform requires.