America is ripe for health-care reform

The grand delusion of health-care reform is that the political fight is about change versus the status quo.

If President Obama and those pushy Democrats would only go away, everything would be back to normal. Reality check: There is no status quo.

Access to health care and affordable medical insurance were disappearing long before a pernicious recession spread the financial contagion to the middle class and beyond.

Quaint tugs of social conscience about providing health care for those other people, are turning into a mad scramble to maintain coverage very close to home. The so-called insured are chopping pills in half as fast as private insurance companies cheapen coverage.

The economic downturn rudely broadened the debate. Employees lost coverage when they lost or changed jobs. More employers can no longer afford to offer coverage, and, in a tight job market, they do not need to provide insurance to attract workers.

Ultimately, as the Congressional Budget Office notes, employees pay for insurance, with lower wages or diminished benefits.

Sixteen years ago, a TV ad featuring a fictional couple, Harry and Louise, helped scuttle President Clinton's health-care reforms. They are back in the kitchen, and their tone is dramatically changed. The new ad, sponsored by Pharmaceutical Research and Manufacturers of America and Families USA broadly promotes affordable insurance with coverage for pre-existing conditions, and insurance not tied to employment.

Turns out Harry and Louise have a familiar story. Harry can barely handle his soaring co-pays and deductibles. His urologists, Drs. Ropy and Frothy, have him on a prescription regimen that is breaking the bank. His arthritis medicine, a brand heavily advertised on television, costs more than the mortgage.

Louise worked part-time. Her hours were cut, and she lost benefits. A new job also came with a new insurer. Those polyps on an old colonoscopy might be considered a pre-existing condition. Her records are under close scrutiny, and the word recision is glowing bright red. Louise, who put on weight and flirts with diabetes, is reluctant to mention persistent bouts of depression.

Sure, I made all that up, but it resonates in a new CNN poll that finds America evenly split on the president's health plan, and versions circulating through three committees on Capitol Hill. Poll respondents have an open mind about change.

For example, Americans see no difference between corporate-insurance bureaucrats and government bureaucrats. No evil accrues to a federal or state employee pushing the paper. People get that Medicare works with substantially lower overhead. Younger people, faced with the new reality of stingy or nonexistent coverage in the workplace, especially like the Obama plan.

Most of us see health-insurance reform as access, affordability and portability. People are looking for transparency in coverage: no lifetime limits or pre-existing conditions. Spread the risk and cost with everyone anted into the game.

Others with a longer view, such as Dr. Carolyn Watts, a University of Washington health-policy expert, expect no "major, major" changes coming soon. Overhaul the fee-for-service payment system?

Watts understands the money, the power and the stakes: Every single dollar of health-care expenditure is someone's income.

Change may be incremental, but what we have now is not affordable, let alone sustainable. This time, Harry and Louise got it right.

Lance Dickie's column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com