John Aravosis of AmericaBLOG has what strikes me as one of the encapsulations of the health care reality that I’ve read. Aravosis writes:

Our health care system is being run by thieves. These people don’t care if you stay healthy or get better, they’re the nasty chairman of the board on House a few seasons back who was simply interested in making money, nothing more.

Democrats need to keep reminding themselves that the problem isn’t just costs. The problem isn’t just the uninsured. The problem is that all of us are bought into a system that doesn’t work. And even those of us who make a good salary for a living (well, in other years) will be in serious trouble if we ever come down with any serious illness that requires $2000 a month in prescriptions (such as MS or HIV).

We need a fix that doesn’t just add more people into a bad system. We need more people in a better system. And the better system needs to benefit everyone, not just the poor, not just the middle class.

This really resonates with my views on health care and the need for reform. It’s not just about covering more people, but giving all Americans coverage that works, that meshes with the reality of treating acute illnesses or chronic diseases. Unless and until we can have a health care system that addresses Aravosis raises in this passage, we will not have an adequate health care system in America. What’s unfortunate is that the volume of opposition to any reform is so strong that anything is likely to win out over the right things when it comes to what is actually done.

The metric for success that the administration and stakeholders should be using when assessing the adequacy of any reforms that are considered should not be how many more people get coverage who don’t currently have it, but if we’ll need to pass another round of reform in the foreseeable future to fix what was not achieved in this round of legislation.

Paul Krugman’s take on the health care industry’s (aka “medical-industrial complex”) announcement that they will find ways to cut $2 trillion from their costs over the next 10 years is informative. Krugman is, in my view, the best liberal bellwether at assessing the administration’s economic and health care policy decisions. While Krugman identifies a number of area of concerns in the announcement from the medical-industrail complex, he’s overall positive and optimistic. When Krugman says the announcement is “some of the best policy news I’ve heard in a long time,” it’s certainly heartening.

What concerns me is what the medical-industrial complex believes these concessions will enable them to push for with the administration. Do they expect the media and the administration to believe this move has necessitated they get a seat at the bargaining table? Will they use the good will they’ve earned to fight against a public health care option in the reform package? Would they embrace any form oversight into whether or not they’re succeeding in cutting their promised 1.5% over the next 10 years? While this isn’t something the administration is saying they’ll do, you have to imagine that at some point a voluntary course of action will not be sufficient to ensure the kinds of cost controls necessary to allow adequate reduction in delivery costs for true health care reform.

I’m not a health care policy expert, but I hope that Krugman’s analysis holds. From a political standpoint – and a long-term policy standpoint – it worries me that any concession from the medical-industrial complex will be met by an imperative for Democrats and reformers to diminish the scope of their goals for change.

Update:

Jonathan Cohn of TNR, who is probably the most knowledgeable liberal health care reporter, has a similar take to Krugman.