The Three-legged Health Care Stool

In a NY Times OP-ED piece, Paul Krugman argues that health care reform is a three-legged stool that cannot be passed incrementally. The legs of the stool are (1) banning insurance discrimination (underwriting), (2) mandating universal coverage and (3) providing financial aid to low-income families. In the long-run, that's probably correct. In the long-run, however, the three legs of the stool, even if all in place, don't address the fundamental health care cost drivers (capital investment/technology, pharmaceutical prices and prices for physician services). In any event, the current legislation won't be phased in for a few years which in politics becomes the long-run.

The way government in the US seems to work is to address one crisis at a time. If passing a law banning underwriting leads to a "death spiral" where "healthier Americans would choose not to buy insurance, leading to high premiums for those who remain, driving out more people, and so on..." then Congress would have to deal with that problem when it happened. Since Congress can only seem to deal with one problem at a time, maybe this is the best that can be expected from our political institutions.

Returning to the analogy, maybe the seat of the health care reform is sustainability and only one leg is social equity (the image above from Sustainability Now!) Maybe Mr. Krugman doesn't have all the legs or even the seat, for that matter.