Not What the Doctor Ordered

November 12th, 2009 at 7:56 am | 5 Comments |

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In 2008, three researchers decided to cost out the expense of insuring those in America lacking health insurance. The Health Affairs paper estimates the price tag at $120 billion a year.

The paper is flawed. First and foremost, the cost of health care to the nation’s uninsured is assumed to be the same as the average for those who are insured. (Remember that the uninsured tend to be younger and healthier than the rest of the population, and not everyone necessarily needs full coverage.)

The authors also assumed that it was the government’s job to insure all 47 million or so uninsured. (Remember that some uninsured are illegals — even the president quotes a figure far lower than 47 million.)

But let’s go back to the price tag. Even with these generous assumptions, they calculate that insurance for all is $120 billion a year away.

On Saturday, with limited debate, the House of Representatives passed health-reform legislation that — when fully enacted — will cost roughly $3 trillion over a decade. That’s the CBO estimate, by the way.

Do the back-of-the-napkin calculation — $120 billion times 10 — and you draw one conclusion: The House bill is about more than covering the nation’s uninsured.

Rather, it’s about remaking the nation’s health care system.

So begins my most recent essay.  The full op ed can be found here.

The central point: there is much to criticize in the House bill.  Yes, the public option would be a public-policy disaster.  But there is much else problematic in the bill, which is too long, too unfocused, too expensive.

Since January, Democrats have insisted that they understand this issue, that they’ve learned from the HillaryCare debacle, and that they’re willing to make the tough decisions to “bend the curve.”

Is it any wonder that Americans are less than persuaded?

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5 Comments so far ↓

  • sinz54

    The NY Times today had an article on Maine’s experience with health care reform. In Maine, health insurance costs continue to soar, because Maine legislators were intimidated out of mandating health insurance for everyone. As a result, many healthy young people continue to refuse to purchase health insurance, leaving it disproportionally for the sick whose claims are large.

    The lesson is clear. Universal coverage means just that–no one should be able to opt out of health insurance without paying a substantial penalty. And by “substantial,” I don’t mean a lousy $900 fine, as the bill now before Congress would do. In this case as in other cases, Congress proved too craven to provide genuine cost containment.

    Remember: We’ve lived with a mandate to purchase automobile insurance for decades. If you drive on an Interstate highway, you are required to have automobile insurance. If you don’t, and you cause an accident on an Interstate, good luck to you.

    Health insurance should be no different.

  • oldgal

    The U.S. does not have a health care delivery system, it has a hodge-podge of insurers, hospitals, labs and doctors, with a very few health care delivery systems in the mix. I am insured by a non-profit health care delivery system that cost 20% -50% less than the other offerings of my employer. The other day I had to go in for lab tests and an appointment (I was notified by phone and email that I should do this). I showed up early and was taken care of right away – my appointment was over 10 minutes before its scheduled time. The next day I got an email that my test results were ready – I logged on, viewed them, reviewed some of the explanations, and graphed them against previous results. Now my doctor is bugging me to make an appointment and I know exactly why. Yes, wouldn’t it be just awful if everyone could opt for a health care delivery system?

  • SpartacusIsNotDead

    Sinz wrote: “In this case as in other cases, Congress proved too craven to provide genuine cost containment.”

    While a mandate is an essential piece, the Massachusetts reform experience proved that a mandate alone will do very little to slow the growth of costs.

    As for cost containment in the Congressional plan, it’s called the Public Option, and no other proposal out there does nearly as much to contain costs, unless you consider a single-payer plan.

  • furrydoc

    There is an intriguing op-ed in last week’s New England Journal on-line feature from a senior statistician in the Israeli health system outlining what they have carved out for their citizens since the mid-1990′s, from accessibility of defined benefits, to availability of added benefits at added cost, to consumer choice to provider participation. Their health care takes about half the GDP that ours does though their defense costs are far in excess of ours. Their political system is also far more fragmented than ours, though probably more fluid in creating temporary coalitions and alignments.

    What they’ve really done that we have not been able to do is capitalize on the areas in which general consensus exists, make a political decision on payment, and create a barrier between what the citizens need and unreasonable profiteering that detracts from the citizens getting basic accessibility to ongoing care.

    While they’ve kept the structure competitive, the consumers select from a menu of about five insurers, including a public one. Here we have thousands though most of us either get medicare or whichever one our employer selects for the company.

  • SFTor1

    In most other areas we look at best practices to learn how to meet challenges. Most bloggers on this side seem to close their eyes to the powerful lessons from the rest of the world. They get brought up repeatedly in the comments.

    The twain shall never meet I suppose.