Ever since the 1960s, there’s been broad agreement within the health policy community that a major cause of America’s exploding health bill is overtreatment – patients are being subjected to costly tests, procedures and drugs that don’t do them any good.

This insight is common to today’s proposed reforms and recommendations made during the Nixon administration to encourage the growth of health maintenance organizations where payments were not dependent on the amount of care delivered.  Current wisdom puts the magnitude of such waste at 30%.

The public is largely aware of this idea and certainly has not bought into it.  Most Americans think the problem is that sick people are being denied the care they need.  Two-thirds embrace this shortfall
theory. Apparently they think that enacting reforms will solve this problem by paying for more care.

What we have here seems to be a failure to communicate.  Someone’s going to be very surprised by the outcome.  It will take all of President Obama’s extraordinary communications skills to assure that they’re not extremely disappointed as well.

The contrast between the public’s learning curve and the limited window open to even a President with a mandate creates continuing tension.  One can argue that one foundation that made the election of a black President possible was enactment of civil rights and voting rights legislation during the 1960s that was not terribly popular and politically masochistic in the way it estranged the South, just as Johnson predicted, from the Democratic Party.

Such gutsy gambles – ranging from LBJ’s creation of the great society to George Bush’s foreign and economic policies to Obama’s health and financial reforms – are based on a calculation that their wisdom will
ultimately become clear to a public that doesn’t fully understand what’s happening at the time of the debate.   Sometimes that happens.

Sometimes not.

This technique is called leadership and is a far cry from one cynical public view of politicians which holds that they can’t decide what to order for lunch without taking a poll first.  Such cautious politicians are few and tend not to be remembered.

President Obama is nothing if not a smart student of history, which explains his effort to maximize success by setting broad goals and leaving Congress to fill in the blanks.  Assuming the deed is done, that means he gets the celebratory headlines while legislators share blame for elements that prove disappointing.

While things are still fairly calm, it would be good to immunize ourselves over the tut-tutting that will occur when Congress ultimately embraces a big, complex health reform bill before the ink on the conference report is try and before even the speed readers among our legislators have an opportunity to read the entire text.

Despite educational efforts by the press, the public will later be at least as surprised some elements as it was by the “donut hole” that punctuated the Medicare drug benefit.

That’s how our system works.  It is often slow and almost always imperfect. But it gets the job done, as tens of millions of current Medicare and Medicaid beneficiaries can testify.

Jim Jaffe is a former congressional staffer and current contributor to Huffington Post and Centeredpolitics.com.