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Much Debate, Little Dialogue

For months the White House and congressional Democrats have treated health care reform like a high school debate competition, emphasizing convenient facts and fanciful arguments in favor of a predetermined position.

Now the other side is doing the same, and the party in power does not like it a bit.

Democratic legislators, home for their August recess, are getting an earful from constituents who are alarmed about what the proposed reforms would mean for them and for the country. Many of the objections are coming via rowdy disruptions at “town hall” meetings, where politicians are more accustomed to greeting friendly audiences. Beyond the rudeness and noise are some patently silly claims (Democrats want to euthanize the elderly and disabled to control costs) and many that are not silly (a government-run health insurer will soon become Medicare for everyone, with no private insurers in sight).

The administration dismisses the objections as being Republican-inspired and politically motivated, an obstacle to the “change” President Obama campaigned on. The only place where the two parties have been talking to, rather than past, one another is the Senate Finance Committee. The Committee’s effort at a bipartisan compromise probably will face a make-or-break moment shortly after lawmakers get back to work in September.

This is all very unfortunate. Lost in the political smoke is an important consensus that has emerged in this year’s health care debate. Virtually everyone agrees that all Americans should have health insurance coverage, and that insurers should be required to accept all applicants regardless of previous health conditions.

The real debate is about who pays.

Democrats argue that more people can get more health care without “average folks” (as Obama likes to call them) having to give up anything. Somehow, electronic efficiencies, employers and 1 million or fewer “rich” families are going to provide coverage to nearly 50 million presently uninsured Americans — all without costing jobs or driving up the federal debt.

Constituents, who know or at least sense that this scenario leaves out many important details, do not seem to be buying it. The administration ignores the fact that Medicare already is en route to a financial train wreck, creating uncertainty about how we will pay for health care for the elderly less than a decade from now. Democratic reform plans would greatly expand Medicaid rolls, putting a major additional strain on already hard-pressed state and local governments. People know it is not only “the rich” who pay state income, property and sales taxes.

As for employers, a new federal mandate would quickly go from being a minimum coverage level to a default coverage level. Employers who now have generous plans, including my firm, would cut back to the minimum to match competitors. I would do this with a clear conscience if I knew my employees all were entitled to private or government-run insurance that they could buy individually. I would pay employees what they were worth and what the law required, and they could make their own health care spending decisions.

Which gets to the last point that Democrats ignore: Many of those nearly 50 million are uninsured by choice. Some are young and healthy and feel they have more pressing things to do with their cash, while others who own or work in small businesses without benefits prefer to take their chances rather than pay high premiums. These business owners and employees essentially mooch off the rest of us, shortchanging themselves and the system when they show up sick at hospitals, get treated and have no way to pay. They are happy to have universal coverage as long as someone else foots the bill.

Meanwhile, the more than 80 percent of Americans who already are covered are beginning to realize that there is no such thing as a free Band-Aid. Democrats who refuse to talk about the real costs of health care now confront opponents who refuse to listen.

Larry M. Elkin is the founder and president of Palisades Hudson, and is based out of Palisades Hudson’s Fort Lauderdale, Florida headquarters. He wrote several of the chapters in the firm’s book, Looking Ahead: Life, Family, Wealth and Business After 55. His contributions include Chapter 1, “Looking Ahead When Youth Is Behind Us” and Chapter 4, “The Family Business."

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