Obama is trying to push his healthcare reform agenda up an increasingly steep hill. It seems ever more likely that the fear of doing something wrong will push us into not doing anything… again. I don’t know if what Obama is proposing is the best plan. This is a grotesquely complex issue and I don’t have the data, the time, or frankly the interest to sort through all the details. But like most Americans, I believe the current system is broken.

What I really want is for the people we elected to office to get off their collective duffs and start cooperating on a solution that works. Quit opting for the sound bites. Quit pining for “Obama’s Waterloo“. Get to work. No solution will be universally popular. No solution will preserve the interests of the groups lobbying for the status quo. But that doesn’t mean there is no solution which works in the interest of the American people.

But what about the costs? How can America afford to reform healthcare? Everyone is screaming about the massive deficits that will result if the healthcare bill is passed. Maybe I’m being overly simplistic about this, but I don’t see why we can’t reform health care at a net profit. Look at the chart below.

The U.S. is spending about double what the rest of the world is on healthcare, and frankly getting worse results. Any reasonable reform has to bring our costs in line with the rest of the world. Which means that all that money, about $2000/person, should now be available to do something else with. The problem is that all that money is currently in the private sector. The reform plans are attempting to simply offset the private sector costs at government expense. Hence the looming deficit impact.

While I don’t have a solution, I do have a strategy to get to a solution. For any reasonable reform to work, it has to start by somehow gaining control of all (or at least most) the money we are currently spending on healthcare. That control can be direct or indirect, but unless it is controlled by some organization operating in the interests of the people/patients it will never be contained. Once controlled the funds may be reallocated toward providing universal coverage, better coverage, reduced costs, or funding other programs. None of which should incur any deficits. The reality is that we are already spending all the money we need to enact universal healthcare and more. It’s just that right now that money is lining somebody’s pockets. Somebody who you can bet will be lobbying mightily against any reform.

Healthcare reform may be the goal, but we cannot afford to enact reform and then hope the money stream straightens itself out. We need to go after the money first, then use that to reform healthcare.