Hoping for the best

The New York Times has published yet another item that describes confusion in the highest American government circles dealing with health care.
The story is one of hope and guesswork by competing experts.
You''ve heard of a pass and a prayer, or a Hail Mary. The image carries over from football to politics. It appears in competing analyses of the 2,000 page health care monstrosity enacted by the Democratic controlled Congress, and currently being challenged in courts and the Republican controlled House of Representatives.
I admire the President''s effort to expand health care, and itch when conservatives claim that it is superfluous because access to emergency rooms provides the best of American medicine. What provokes me is the product of the Democratic White House and Congress so complex and so based upon wishful thinking. Yet I''ll excuse the people responsible in the light of the similar quality of analysis presented by their Republican adversaries. The high intensity of the political debate does not match the low quality apparent in key points of analysis. 
As I see American health care, its essential flaws come from the power of loosely-regulated, profit-oriented health insurance companies, and the inability of politicians to cut the companies to the ground and build a system resembling any one of the numerous ways of doing things that have provided almost 40 countries with better health indicators than the United States.
In my limited experience I have encountered senior professionals in academia, medicine and law (including a government lawyer with decades of experience) who admit their inability to determine the benefits due to them from existing or proposed medical plans.
There is no way that the United States can junk existing ways of providing health care and start over with a clean slate. Whatever is done will continue the decades long process of partial cure, or putting patches on patches, and leaving insurance companies as the gorillas in the living room. 
As current arguments are reported by the New York Times, here is one Hail Mary
"In its official analysis, the (nonpartisan Congressional Budget) Office estimated that the cost of new benefits in the health care law would be more than offset by revenues from new taxes and by cuts in projected Medicare spending, reducing future deficits." (emphasis mine)
"The office has also said that lawmakers may find it difficult to follow through with some aspects of the law, particularly cuts in projected Medicare spending. If the cuts do not take hold, the cost of the law could soar." (again mine)
Part of the debate is whether the present law will add to or lessen unemployment. Republicans claim that the added costs of health care would lead employers to limit their workforces, or rely more on temporary help. 
Against this,
"Democrats say that if the law provides coverage to more than 30 million currently uninsured people, as intended, it will increase demand for medical services, thus creating new job opportunities in the health care industry.
"With respect to general levels of unemployment, the New York Times reports
"Many economists say the effects on jobs are likely to be modest. Most large companies already provide health benefits to employees. And many small businesses will be exempt from penalties if they fail to do so."
What this does not say is whether there are enough health care personnel to supply services to an additional 30 million insured customers. It should be possible eventually to recruit enough care providers, and fairly quickly in the case of easily trained aides, but it may not be possible to find enough unemployed physicians and nurses in the near term. Unless American hospitals and HMOs increase their hiring in other countries,  Americans will be spending more time waiting for diagnosis and treatment.
Given the economic weight of American recruiters, they will return from Africa, India, Latin America, the Philippines and elsewhere with some decent personnel. I have had good medical experiences with professionals who did not look like me. What an upsurge in American recruiting efforts will do to the services provided in poor countries is another matter.
The irony of American health care is the developed world''s worst delivery system cannot help but fail in providing access to the world''s best medicine in one of the world''s richest countries. The President''s reform will provide more people with insurance, but many of them will not have good insurance. There is little in the current debate to help Americans judge how many people will be under-insured, how much the changes will cost, and who will pay the bills. Neither is there assurance about how long it will take the country to inch up from the embarrassment of severe retardation with respect to comparative health indicators.