Here’s how health care reform should have worked.

Republicans, Democrats and just about everyone else should have agreed on the old system’s strengths and weaknesses. On the plus side, modern medicine has added to quality and length of life in sometimes amazing ways. Moreover, it has generally been made available to everyone, regardless of their ability to pay, if the circumstances are serious enough.

However, the system has cost too much and hasn’t covered everyone the right way. Health care consumes 18 percent of the country’s gross domestic product, quite a bit more than the rest of the industrialized world spends. It has become the primary driver of our national debt and is bankrupting individuals.

Families who make too much money to qualify for Medicaid but not enough to afford health insurance wait until they are really sick to get care. Medical providers waste their resources on bureaucracy and paperwork, often not knowing if they will be paid for their services. Americans with pre-existing conditions have been left without coverage or been forced to remain in dead-end jobs for fear of losing their insurance. Preventive care has been an afterthought.

There even could have been widespread agreement on the root cause of these problems: The incentives are all wrong. The system financially is incentivized to treat us, not cure us and certainly not to keep us well. Patients are not sufficiently incentivized to take care of themselves.

The president, with the support of Congress, should have started a national conversation and then mostly gotten out of the way. Medical providers, insurance companies, large and small businessmen, elected officials and citizens should have been involved. Communities across America should have discussed how to fix this system that works such wonders so inefficiently.

Reforms should have been enacted gradually, with states serving as the laboratories of democracy. A consensus should have developed incorporating ideas from across the political spectrum. For example, the term "pre-existing conditions" would have disappeared, as it does, rightly, under Obamacare. Meanwhile, as Republicans have been saying, there should have been significant medical lawsuit reforms.

This should have taken many years.

Unfortunately, it all happened in 2009 and early 2010. Our political system makes it hard to have a lengthy conversation about anything because we have to yell at each other during elections that occur every two years.

So is it too late — is it even possible — to have the conversation that should have occurred in the first place?

Last week, a group of 33 House Republicans, including all four from Arkansas, wrote President Obama a letter asking for a meeting in response to his statement that Republicans should bring their ideas to him. The signers agree that "our health care system needs significant reform," according to the letter, and they list a number of proposals.

Rep. Tim Griffin, who represents Central Arkansas’ 2nd District and helped spearhead the effort, said in an interview that there’s no way Obama is repealing Obamacare. However, he said it’s a false choice to say that it’s either Obamacare as it exists now or the old system.

"My point is, there are a lot of different things we can talk about, and we need to have that conversation," he said. "Because here’s the thing, as (Margaret) Thatcher always said, first you need to win the argument. You need to demonstrate to people that you’ve got the ideas, and … I believe we have the best ideas, and I think we ought to have a conversation about it."

I’m not sure if anybody’s ever going to win the argument, but it would be great to finally have the conversation that didn’t happen in 2009. Some may want Obamacare to go down in flames, but I don’t think we can go back to the old system, and I don’t think we want to. It would be better to move forward with something superior to both and call it whatever it takes to get it passed.

Instead of talking about repealing health care reform, which isn’t going to happen, we should talk about reforming the reform. That would require people to meet, right?


Steve Brawner is an independent journalist in Arkansas. His email address is Follow him on Twitter at @stevebrawner.