Comprehensive reform is not in the cards. Anyone who thinks politicians can overhaul the nation's healthcare system with one grand sweep is living in a dream world.
Need evidence? Just look at the failure of the National Bipartisan Commission on the Future of Medicare to reach consensus after struggling for more than a year. It was reform debacle deja vu as the panel of nine Democrats and eight Republicans disbanded without recommending a fix for the financially struggling insurance program for seniors.
Now the Medicare issue is headed to Congress, but those folks couldn't agree on a plan to clean up dog poo if it was blocking their path to a fund-raiser.
A major transformation is unlikely because:
Not that it's easy to reach consensus on what the problems are -- even for those within the healthcare industry. For example, some providers think technology is the culprit behind high costs; others think it's inefficiency, greed or fraud; and still others blame administrative overload. Furthermore, any effort to deal comprehensively with the issue upsets so many interests -- political, professional and otherwise -- that reaching agreement seems hopeless.
The country has been down this path several times in recent years. Those with fairly good memories recall the storm of controversy set off in 1993 after President Clinton unveiled a bureaucratic healthcare reform proposal built on an untested theory called managed competition.
Those with better memories recall the hell that broke loose in 1989 when Congress decided to add a catastrophic illness insurance plan to Medicare -- and proposed making seniors pay for it. Angry seniors rose up en masse. In Chicago, a group of elderly men and women chased former Rep. Dan Rostenkowski (D-Ill.), then chairman of the House Ways and Means Committee, down the street during a visit to his home district. Congress was forced to roll back the benefit soon after.
So once again, let's remember that any effort to reform healthcare must be incremental, focusing on changes that are measured, moderate and -- let's hope -- continual. Here are several tactics Congress might consider for starters: