BELLS AND WHISTLES. Over at OpinionJournal a Daniel Henninger column runs under the Jacobin headline "Patient Rage: Consumers march to the walls of the health-care castle." The input considered, however, is not from consumers, but from politicians, providers and their middlemen, the corporate human resources administrators who try to limit the effect of rising health-care costs to employees under their jurisidictions.

Henninger notes that most citizens get their health care coverage from the company store, so this area is where the "real action is," leaving concerns of the uninsured (14.6 percent of Americans, per the last census, and steadily rising) and Medicare recipients to one side. This ellision would seem to guarantee a less depressing picture of national health care right off the bat, but as it turns out, even these beneficiaries are not immune to rising costs, as any covered employee who saw his premiums and deductibles increase in the past year will suspect. Employers are trying all kinds of tricks to hide the damage -- for example, many of them are slashing benefits to retirees, which is a neat way to hide cost-cutting from those workers still at their desks -- but even Henninger cannot deny that companies "are taking employee premiums higher for more or less flat coverage."


And so a conference was convened by the World Health Congress; Henninger was its keynote moderator, and most of his article is based on testimony to that Congress.

The good news, such as it is, relies largely on the standbys of any modern and failing system promising that things will get better soon: technology ("brighter explosions are also in health's firmament... remote medical sensors, implanted monitors, Web-based health-care 'wizards'") and innovation. These benefits include "Web-based programs and human 'coaches' who give guidance on dealing with chronic aliments or complex medical problems," "a consumer-directed plan with a year-to-year financial rollover for its own workers, 'many of them single mothers,'" and "put[ting] a greater decision burden on workers."

All this makes Henninger optimistic. But haven't we attended this sort of presentation before? The Federal Government was going to be "reinvented," the internet was going to shift the very paradigm of business, and privatization was -- is! -- going to restore Social Security. Yet at the end of the day we get a lot of geegaws, new processes and metrics, and decreased services. The shrinking of the Federal deficit (remember that?) was largely paid for, and bought into, by reducing expectation of services from the Government. Given the way things are going, I doubt the reformation of health care will work any differently.

Time was when the powers that be distracted us punters with bread and circuses. Now we get bells and whistles. But if your kid needs her tonsils out, I don't see how they're going to make things any easy. Perhaps, given the glorious promise of "remote medical sensors" and such like, I'm being insufficiently forward-looking. But many of us can only look forward to the next (or present) medical exigency, and wonder how we're going to pay for it.