Obama's 'Hope Without Change' on Health Care Policy

[T]he status quo is untenable. ... [E]verybody understands we can't keep doing what we're doing...whatever it is that we're doing right now isn't working. ... [I]f we don't do anything, costs are going to go out of control. Nobody disputes this. Medicare and Medicaid are the single biggest drivers of the federal deficit and the federal debt by a huge margin.

-- President Barack Obama, June 24, 2008, ABC News Special.

[I]f you are happy with your plan and you are happy with your doctor, then we don't want you to have to change. ... So what we're saying is, if you are happy with your plan and your doctor, you stick with it. ...  [I]f you're happy with your plan, as I said, you keep it. .. For us to completely change our system, root and branch, would be hugely disruptive and I think would end up resulting in people having to completely change their doctors, their health care providers in a way that I'm not prepared to go.

--President Obama, same program

There is a disconnect in the Obama administration's rhetoric on health care. On the one hand, the administration points out that our current health care financing system, particularly for government-funded programs, is unsustainable. This suggests an urgent need for major reform.

On the other hand, the administration is quick to reassure Americans that they will be able to keep the same insurance and maintain the same relationships that they have with their doctors now. As individuals, most Americans are happy with the status quo, and the Obama administration does not want to appear to threaten their satisfaction.

The administration is trying to position Obamacare as solving problems in our health care system that are real and fundamental while allowing individuals to continue with business as usual. The administration has decided that the best way to appeal to voters is to offer hope without change.

As individuals, we want unlimited access to medical services without having to pay for them. The problem is that if everyone enjoys unlimited access, paid for by insurance or government programs, health care spending will grow out of control. Such a system is unsustainable.

Many people want to believe that health care policy is a matter of villains and saviors. Villains include drug companies whose profits ought to be squeezed, doctors whose pay ought to be cut, or health insurance companies with excessive overhead. Saviors include electronic medical records or increased reliance on medical prevention.

However, research by health care policy experts, such as those at the Congressional Budget Office, shows that villains and saviors are not the key to controlling the growth of health care costs. Instead, the problem is that Americans make extravagant use of medical procedures with high costs and low benefits.