Campaigns promise generalities but laws have to be specific. The health care disaster shows how difficult the road from promise to result is.

The current mess simply tried to do too much. There are two main problems in health care: cost and coverage.

85% of Americans have coverage that they are reasonably happy with. Costs are high for many reasons. We want short waiting times and high quality. We have some the best outcomes for most major diseases and access to wondrous new drugs and technology. Part of the reason health care is expensive is because we value it so much.

Yes there are administrative inefficiencies, but the cost shift from underpayment from government programs drives up costs much more. If one wanted to help drive costs down we would discuss tort reform, allow insurance companies to cross state lines, promote health savings accounts, promote final directives, and stem Medicaid fraud.

But rather than address the problems of the 85% they sought to address the 15%. Yet those without coverage are not without health care. And a case can be made that those 15% are closer to 5% when you exclude prisoners, those already qualified for government programs, illegal aliens, and those able to buy health coverage who choose not to.

But the difficulty comes when you require medical underwriting without pre-existing conditions. This sounds great but there are still two critical problems. Without forcing everyone to buy insurance people would simply wait until they needed it and the claims experience would drive costs sky high.  Without compressing the difference in premiums based on age, the older American’s would just get guaranteed coverage that they could not afford.

Both of these place an undue burden on the young.  Yet If we want to get health insurance into individual hands then we need some assurance that individuals can get reasonably priced insurance.

We could treat health insurance like a life insurance contract.  The younger you are the cheaper it is. You could lock into a plan period with restrictions on increases.  This is essentially an HSA.  When you are young with few claims you can build ‘cash value’ that can be tapped when you are older. This can be encouraged with individual tax credits for individuals to buy their own health care.

We tend to treat health insurance like auto insurance except that we file a claim for every oil change and flat tire. No wonder administration costs are high.

The problem is that the government wants to provide a benefit but not incur the cost. This leads to more cost shifting , some form of rationing, or lower quality care.  Proponets of more government involvement in health care contend that market forces do not work in the health care field.  I disagree; it responds to market forces too well.

Brown’s victory over Coakley is certainly a setback for the current administration no matter how they spin it. But another major development in the electoral process was largely missed.

When Ben Nelson flipped for Obama Care in the Senate it was seen as a betrayal of his pro life principles.  Yet Nelson likely thought he was doing his job of bringing home the bacon for his Nebraska constituents by getting such special treatment to offset his state’s higher Medicaid cost.

In the past anti-incumbent fever was directed at other politicians; ours was OK as long as he succeeded in protecting his constituency’s interest. In this case the uproar from Nelson’s own state was overwhelming. This was very different;  the governor and the citizens of Nebraska were no longer concerned in benefiting from special deals if it meant voting for bad legislation. Such a voter attitude could spell the end of pork barrel politics.

The climate of voter outrage is reaching beyond anti-liberal, partisan preference, and even anti-incumbent.  A certain level of ‘corruption’ that was an accepted part of American politics is being soundly rejected.  Closed door meetings, blatant partisanship, unaccounted for expensive trips, unmitigated arrogance, broken promises, and blatant hubris and hypocrisy is being rejected as components of our political scene.

This change will hopefully encourage a new kind of political leader from both parties to enter the political scene.  The exit of the old guard who clearly sees that they cannot get re-elected will help this process.

A new center is emerging that in intolerant of political gain at any cost. I don’t think they are going to back down.