Book of the Month

DF's picture

But How Will We Pay For It?

by DF 7/24/2009 - 11:45 am   |

I don't have a whole lot of time to write this, but I'm hoping that the core questions I'm going to forward here will be compelling enough to stand on their own.  As I prepare to leave for the day, I'm listening to NPR.  I've been quite busy lately and haven't had the time to read as much as I like, but I've been trying to follow the political developments of health care reform.  It seems to me that this week we've gotten down to a new meme: "How will we pay for it?"

How indeed.  What strikes me about this talking point is that it is so radically disconnected from reality.  The reality is that we're already paying about twice the median per capita cost of comparable industrialized nations.  As far as I'm concerned, this cannot be pointed out often enough.

So, you could ask, "How will we pay for not doing it?"  Because that's already pretty damned expensive.

However, an even more interesting question is, "Why should we pay for not doing it?"  Even if we didn't reduce costs at all, but merely held steady at current levels of expenditure, by switching to a public insurance plan, wouldn't that be worth it if we were able to do so and everyone ended up with access?

Of course, there's little reason to believe that a public plan wouldn't drastically reduce costs.  Even more important, to my mind, is that it would actually represent a move to create a health care system.  Because we don't have that right now.  We have many high-quality health care providers, if by that you're talking about doctors, nurses, hospitals, etc.  But none of us can afford to pay these people directly.  We rely on the collective bargaining and risk distribution of insurance.  However, our insurance system has devolved into a government protected oligopoly of regionally dominant, rent-seeking cartels.  It is not a health care system.  It does not exist to provide health care to anyone.  It exists precisely for one reason: To turn a profit.  These companies have nothing short of a fiduciary duty to their shareholders to increase value and they do not do this by providing the best quality care at the lowest price.  That would be a competitive market.

That's not how they operate.  They operate by cherry-picking the young and healthy while Medicare picks up the tab for the most costly patients, the sick and elderly.  They operate by making sure that they never end up having to actually pay for someone's care if they can possibly avoid it.

The only people who benefit in this system are people who don't need health care and the people who don't provide it.  That's not a health care system.

When I hear craven politicians wringing their hands over cost containment, I don't care what color their dogs are.  Instead, I hear this: "You will continue to pay for this."  They're not worried about what kind of damage is being done by the status quo, because they are defending it.  The current system could not exist without its government protectors.  When you hear them bitching about the costs of reform, you know their names.  You should know who they are speaking for.  Unless you're a private insurer, it's not you.

Awesome, DF!

by Orlando 7/24/2009 - 12:28 pm

Well said, DF.  As a nation, we wold save so much money if we switched to a universal, single-payer health system like the one in Canada or many countries in Western Europe.  As for the patient, imagine going to the doctor and knowing that you're not gonna get random bills in the mail for $50 or $75 when you're not even sure what it's for or whether the insurance company should be paying for it.

Imagine going to the doctor to get something checked out and not having to be concerned that a diagnosis might hand you a pre-existing condition that'll disqualify you for insurance in the future if you switch jobs.

I'm just worried that the Dems will negotiate away the government's power to bargain with insurance companies about the cost of drugs or services (viz. Medicare).  I'm concerned that if the govt insurance program can't dictate the cost of drugs and services, it'll be almost as expensive as private insurance, and Repubs and insurance-company lapdogs will point to the public option as a big failure.  Don't back down, Mr. President!

by scofflaw 7/24/2009 - 5:29 pm

Great post, DF.  I am still stunned that big business and the Chamber of Commerce are opposed to the public opton and health care reform.  Premiums are rising about 5% each year.  And for employers that subsidize those costs are hurting the bottom line which means they either reduce the level coverage.  How much more competitve would GM have been if healthcare was not a major cost for them?  There's a reason why Wal*Mart is hopping on the health care reform bandwagon. The status quo is untenable and everyone knows it.  We cannot be a competitive nation if healthcare costs continue to skyrocket.

by dijamo 7/25/2009 - 12:52 am

This is a great post DF.  And dijamo, I have the same question about business and health care.  Health insurance should not be the responsibility of business.  Why hasn't anyone else talked about GM and their health insurance problem. 

I just did a quick google and came up with this http://www.lacrossetribune.com/articles/2009/07/25/news/z06health.txt

High lights -

Tommy Thompson spoke at a Business Health Care Forum yesterday and noted that health care in the US is about 17% of GDP and about 7% in Japan.  Health care added $1725 per car for GM and $225 per car for Toyota.  He talk about how US business could NOT be competitive globally with health care remaining as it is.

I thought the Republicans stood on the side of big business. 

by Bluesplashy 7/25/2009 - 9:13 pm (re: dijamo)

My problem runs in the same direction as your reaction to "How Will We Pay For It?" but is a little different.  Why in the world should reform be in tension with decreasing costs?  The debate about how reform will increase costs, or is cost-efficient... geez, can't we both want more folks covered on one axis, and want costs contained on a separate axis, no matter how many are covered?  It's not a valid subject change to move from equitable arguments for reform to stressing cost-containment.  The system at all sizes you can postulate needs more efficiency.

A separate peeve I have is that anyone who thinks that doctors and insurers aren't presently engaged in rationing is delusional.  I pay so much for coverage and make a lot of money.  And even for me, a theoretically privileged actor in the system, some of the weird triage-type strategies that doctors have deployed with respect to a recent medical event with me have driven home very powerfully to me that they ration.  I am thus unimpressed with rants about government involvement.  The insurance monopsony rations plenty aggressively in the status quo.  As do doctors with certain received-wisdom approaches which are cost-conscious but which are not sensitive to individual situations.  More about this from me later.

Today I was in an airport and saw a headline GOP:  Health Reform Will Be Disaster.  I am wondering when we will see a headline GOP:  Health Care Status Quo Is Awesome, and maybe populist rallies with a Bob Roberts-type figure composing acoustic guitar riffs on the adequacy of the system, the extent of coverage within it, and its efficiency, while he tosses teabags to an adoring throng.

by Articleman 7/25/2009 - 10:42 pm

Latest Comments

more