Childhood gets no medical do-overs

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Paying for partial reform

If comprehensive health-care reform fails, is there a feasible plan B that can advance us toward the goal of universal coverage?

An alternative must break down complex policy problems into manageable sub-problems and accommodate the political need to concentrate benefits to galvanize support and defuse costs to avoid generating opposition from powerful interest groups. Stepping back from all the important transactions and political interests involved in health care allows us to view three greatly intermingled forests among the trees:

The delivery of health care: what goes on as doctors, nurses, psychologists, hospitals, etc., promote the health of individuals and communities;

Obama's intrusive public plan

To dissect today's health care debate, the crux of which concerns a "public option," use the mind's equivalent of a surgeon's scalpel, Occam's razor, a principle of intellectual parsimony: In solving a puzzle, start with the simplest explanatory theory.

The puzzle is: Why does the president, who says that were America "starting from scratch" he would favor a "single-payer" -- government-run -- system, insist that health care reform include a government insurance plan that competes with private insurers? The simplest answer is that such a plan will lead to a single-payer system.

Conservatives say that a government program will have the intended consequence of crowding private insurers out of the market, encouraging employers to stop providing coverage and luring employees from private insurance to the cheaper government option.

Opening up to choice

The Baucus bill has a radical notion at the heart of its strategy to expand insurance coverage: Individual consumers should exercise free choice in picking an insurance plan, and health insurers should compete for their business. In doing so, the ranks of the uninsured would decline, and competition would bid down premiums for individual coverage, slowing health-care cost inflation and making insurance more affordable.

Choice and competition are bedrock values in our culture, but they are rare in health insurance. In fact, insuring all Americans via Medicare would be a smaller cultural departure than would creating a functioning market for health insurance in which individuals do their own shopping.

After all, everyone will eventually be covered by Medicare if they live long enough, but a robust market for individually purchased health insurance has not developed.

What cancer patients can tell us

Congress is on its annual August recess. Yet after failing to meet President Barack Obama's self-imposed deadline for action on his No. 1 domestic priority -- health care reform -- this traditionally sleepy month junkets and district town halls will be transformed into a national grass-roots debate over every item in the bills. Many town halls are likely to feature average citizens -- including countless cancer survivors -- who will gladly share their stories with the current health care system. Their experience should be very informative and should illustrate several changes that must be made to our health care system.

One of the chief issues Congress is confronting is what to do with the nearly 46 million Americans who lack health insurance. Some may ask, from a health outcome perspective, whether it really matters if people are insured. Considering cancer, the answer is clearly yes -- it does matter.

A lack of adequate health insurance has a decidedly negative effect on cancer screening rates, as

The cost equation - especially of doing nothing

You can expand insurance coverage without controlling costs, but you cannot control costs without expanding insurance coverage.

The bill that passed the House on Nov. 7 is an example of the first possibility; a plan that sets up a reasonable market for individually purchased health insurance for the uninsured and expands Medicaid, resulting in 96 percent of legal residents being covered in 2019. Even though the Congressional Budget Office says the bill would reduce the deficit over the first 10 years, it unfortunately punts on the hardest decisions necessary to fundamentally slow cost inflation over the long term. However, such decisions could be made later because expanding insurance coverage substantially is a precursor to successful cost control.

Delays in the Senate and abortion's muddying the reform debate have increased the probability of doing nothing. One of the hardest things in evaluating public policy is to understand what doing nothing really means. If no reform is passed, it means three fundamental