E.J. Dionne nails it

In a recent Washington Post column, E.J. Dionne got to the heart of the Great Health-care Holdup of 2010 better than pretty much every other writer I've read. The piece spotlights an exchange between President Obama and Sen. John Barasso (R-Wyo.), who is also a doctor:

Addressing Obama, Barrasso suggested that we might be better off if people were insured only for catastrophic care. "Mr. President, when you say [people] with catastrophic plans, they don't go for care until later, I say sometimes the people with catastrophic plans are the people that are [the] best consumers of health care in . . . the way they use their health-care dollars."

"A lot of people" with insurance, he added, "come in and say, 'My knee hurts, maybe I should get an MRI,' they say. And then they say, 'Will my insurance cover it?' That's the first question. And if I say 'yes,' then they say, 'okay, let's do it.' If I say 'no,' then they say, 'Well, what will it . . . cost?' And 'What's it [going to] cost?' ought to be the first question. And that's why sometimes people with . . . catastrophic health plans ask the best questions, shop around, are the best consumers of health care."

Obama played the old TV character Columbo, who thrived on posing seemingly naive questions: "I just am curious. Would you be satisfied if every member of Congress just had catastrophic care? Do you think we'd be better health-care purchasers?"

Barrasso answered in the affirmative, though he didn't propose that senators dump their present coverage. Obama came right back: "Would you feel the same way if you were making $40,000 . . . because that's the reality for a lot of folks. . . . They don't fly into [the] Mayo [Clinic] and suddenly decide they're going to spend a couple million dollars on the absolute, best health care. They're folks who are left out."

Obama concluded: "We can debate whether or not we can afford to help them, but we shouldn't pretend somehow that they don't need help."

One more time: "people with . . . catastrophic health plans ask the best questions, shop around, are the best consumers of health care." What Barrasso is saying is that forcing people into scarcity thinking by ensuring actual scarcity makes them smarter consumers. It's not a big leap to suggest that we ought to let poor, marginalized people stay poor and marginalized, since helping them would cloud their minds, which years of indigence have polished to crystal clarity. On the other hand, Obama's response to Barrasso is one of the president's finer recent moments. The folks who grumble about his supposedly weak leadership on health-care reform should pay attention to the way he's continuing to push for it, undeterred by the GOP's nonsense.