The difference is clear from the first page. The bill released by House Democrats states that the legislation is meant “to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.” The “amendment in the nature of a substitute” by John Boehner says, “The purpose of this Act is to take meaningful steps to lower health care costs and increase access to health insurance coverage (especially for individuals with preexisting conditions) without –

(1) raising taxes;
(2) cutting Medicare benefits for seniors;
(3) adding to the national deficit;
(4) intervening in the doctor-patient relationship; or
(5) instituting a government takeover of health care.”

You can hate the Democratic bills, but they are at least thorough enough to say what they are going to do and then tell you how they are going to do it.  You may think it costs too much, or has too much regulation, or is unfair to the insurance industry – but at least it’s there.

This plan promises the impossible.  It will lower costs and increase access without collecting any more money, making any cuts to anything, or changing anything about the way we practice medicine.  Right.  I mean, who knew it was going to be so easy?  We should have done this years ago!

I wish Speaker Pelosi would call their bluff.  I’d like to see a CBO score of this “proposal”.  Tell me how many more people will actually be covered.  Tell me how much their insurance will cost.  Tell me how much this bill will reduce the deficit.

People can make fun of the length of the other bills, but one of the reasons they are so long is that they actually say something.  As I said before, there are serious conservative ideas for health care reform.  This “bill” contains few of them.

I am writing to disagree with a claim I’ve heard you make a few times, and have now seen on your blog, most recently in the “How about we start here?” entry.  In particular, I strongly disagree with:

“Anyone who tells you that they can increase the number of people with coverage, improve quality, and reduce cost is lying – or a politician… Do you want to improve access?  Then you need to admit that it’s going to cost money, and you have to discuss how we are going to raise that money.  You may also want to address how this will affect the quality of everyone’s care, because it might.”

and especially:

“Do you want to bring costs down?… It’s going to have to come in the form of either covering less people or spending less on health care.  That can negatively impact quality.”

Given that you yourself have often noted that many or even most developed countries have close to universal access and their overall health and health outcomes are generally superior to the US, yet they spend between one third and one half of what the US does, doesn’t it seem self-evident that the US could do so as well, if only it chose to?

I think the reader missed my P.S. at the bottom, where I say:

P.S.  Alternatively, we could scrap the whole system and start over, doing better in all three domains.  Pretty much every other comparable country in the world does so.  Seems pretty rational, so it’s ironic that not doing that is the one thing everyone in this fight seems to agree on.

This is an important point, so I’m going to say it again.  The iron triangle* of health care applies when we try and make incremental changes to the system.  I can’t take what we have – right now – and increase access without somehow affecting costs and/or quality.  Nor can I cut costs in the current system without somehow decreasing access or decreasing quality.  It’s common sense.  We could start over, but no one seems to be talking about that at all.  So if you are committed to “keeping what works and changing what doesn’t”, the rules of the iron triangle apply.

*My first exposure to the “iron triangle” came in a medical school class taught by William Kissick.  I’m embarrassed to say that the class was graded on attendance, so I might not have paid as close attention as I should have.  Especially given what I do now….