Commentary: We don't have control over our health care now

There's a lot that's disappointing in the health care reform efforts in the Congress, which do far too much to mollify all the "interested parties" except patients and far too little to bring about changes that could hold down costs while providing better care. There's a lot of room to debate precisely what "reform" should include and how it should be paid for.

But so far the debate has revolved around fantasies about what we have now and paranoia about what we're likely to get.

The biggest fantasy — which you must indulge in order to believe that we risk losing control of our medical care — is that we as individuals are in control of our medical care today.

We are not. At least not if you define "control" as doing whatever you want to while someone else pays the bills, which is the way critics mean it when they insist that we will not be in charge in the "government" program that they insist will be forced upon us despite all evidence to the contrary.

We do not decide which doctors we will see, which tests and procedures will be performed on us. Our doctors do not decide which drugs we will take, or even how often we will see them.

Our insurance companies make those decisions, and our employers decide which insurance company we have to conform our medical care to.

Oh, we can make all the decisions we want — as long as we are willing to pay for it. Just as we would be able to do under every single plan in the Congress that anyone with any credibility is proposing.

My insurance company "prefers" blood-glucose test strips that my doctor and I have concluded are far inferior to the ones I use, and so I spend $39.67 a month instead of the $15 I'd have to pay if I didn't insist on having some control over my own health. My insurance company doesn't like my ophthalmologist of nearly two decades. I still see him, because I can afford to pay for an annual office visit. But if I needed major eye surgery, I would have to switch to a strange new doctor the insurance company sanctions, because that would be too much of a financial hit to take.

Mine are minor sacrifices compared to the ones faced by people who (like me) do not meet the insurance companies' definition of perfect health and who (unlike me) don't work for a company that provides insurance. If you don't have group health insurance through an employer but do have any sort of "pre-existing condition" — that is, if you actually need to see a doctor and take prescription drugs and have tests done — then chances are good that you don't have insurance, because the insurance companies price you out of the market.

The paranoia that's central to the debate involves what happens after the Congress passes whatever it passes.

After the more responsible critics kept getting called out when they claimed falsely that the plans being discussed were built around bottom-line rationing — no bypass surgery for anyone over 65, since they're going to die anyhow, two-year waits before a Stage IV cancer patient could see a specialist, and on and on ad absurdum — they resorted to claiming that this would be the inevitable result of any Obama-approved legislation.

This is brilliant, because unlike the absurd "death panel" fabrication, it can't be proven untrue It can, however, be proven ridiculous: The fallacy is that it assumes the Congress would ever approve anything so wildly unpopular.

This is the body that, even under Republican control, passed a massive new Medicare drug benefit that it knew it couldn't pay for but was afraid to reject after getting old people's hopes up. It's the body that won't make Medicare solvent by imposing the same sort of managed-care rules that everybody in the private sector has been living with for more than a decade; won't even put limits on the benefits of people who can afford to pick up part of the cost. It's the same body that won't shore up Social Security by raising the retirement age in any serious increments, to keep up with increasing lifespans. Won't slash farm subsidies to people who don't farm, won't slash defense expenditures to companies that make weapons systems that don't defend us.

And we're supposed to believe that it's going to impose draconian rationing on medical care? On everybody in the country? Or (as the senior-focused version of the paranoia goes) on the most active voters? We're supposed to believe that it's going to intentionally constrict the supply of some of its most faithful campaign donors (doctors and, by extension, trial lawyers, who would have fewer people to sue) in order to create artificially long waits in an attempt to discourage people from seeking treatment?

The problem with the Congress — not just the current one, but every one — is not that it's so fixated on the bottom line that it would endanger our health if it was in charge of our medical care. The problem with the Congress is that it can't do anything that's unpopular — no matter how much it might need to.

Doctors and hospitals might be right to worry that a large public option would result in the government squeezing their reimbursement rates. Insurance executives might be right to worry that they couldn't print their own money if the government set some rules or else ended what is for all practical purposes their monopoly status.

The rest of us, however, have no reason to worry about anything except the nation's fiscal health, even if the day were ever to come when we were forced into a "government" health care system — which no one with any credibility wants to force us into.