Dr. Maccoby participates in a Weekly Forum on Washington Post.com called "On Leadership". I am compiling all of his responses to the weekly questions here.

The health care imperative

A major role of leadership is education. Our leaders deserve a failing grade for educating the American public about what it takes to put this country on the path to economic as well as physical and mental health.

As long as Americans believe the solution to deficits is lower taxes so people will spend more and businesses will produce higher profits and increased tax revenues, they will reject any leader who calls for tax increases. That belief is one reason why America has such a huge deficit.

The Bush administration believed in this philosophy which seemed to work with JFK and Ronald Reagan, it didn't work for them. They showed us how government could ruin the economy with unfunded spending on two wars, a costly drug benefit for the elderly and a tax cut for the rich. Many Americans believe that government can't improve the economy. That skepticism undermines the attempt to reform health care, including medicare which is a major cause of the growing deficit.

Ideally, health care legislation should achieve the five goals agreed to by the members of the National Coalition on Health Care: universal insurance, cost control, improved quality of care, administrative simplification, and equitable financing. But it would take exceptional leadership to explain how these goals interact. Many Americans see no benefit for them in the health care legislation. People suffering from the economic down turn resent what they see as signing over their hard earned tax dollars to others who get a free ride. And Medicare beneficiaries imagine cost control will cut their benefits.

Americans can be very generous with people who have suffered a natural disaster as in Haiti and New Orleans. They can adapt to painful challenges when they see the need to do so as in World War II. But neither the president nor congressional leaders have made a clear case to the American people for tax increases nor for decreases in the services they receive from government. They have not convinced the public that unless we reform health care, costs will continue to rise and more Americans will lose their insurance. And our leaders have not inspired voters by showing how legislation could improve the health care system and move it in the direction of our best health care organizations which are globally admired for their quality and cost effectiveness.

It's not too late to pass legislation that includes the key elements of the Senate and House bills. If it does not pass, increased medical costs will continue to balloon the deficit and an increasing number of Americans will lack health care. Whatever happens, we will need the president and congressional leaders to become better teachers.

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