Elected officials considering health care reform would do well to adopt the “first, do no harm” rule. So far, they haven’t.
Health care reform proposals circulating among the States run from the broad and all-encompassing (California) to the very narrow (Texas). The big ones suffer from an inherent problem – the broader they are, the more oxen they will gore. As every constituency works to protect and advance their agenda, the big proposals run the very real risk of the death by a thousand cuts (a particularly gruesome, excruciatingly painful Chinese execution, and therefore a perfect analogy).
Narrow, specific initiatives to address discrete issues have the opposite problem – they tend to fix problems caused by the system, instead of fixing the underlying problem.
Look at Texas.
Harvey Kronberg’s synopsis of political happenings in the Lone Star State reports Gov. Perry will ask for a 3% tax on all hospital bills, with the proceeds going to increase reimbursement for providers hammered by much-too-low Medicaid reimbursement rates and/or provide health savings accounts to Medicaid recipients and/or fund an insurance puchasing pool to help employers and employees obtain coverage.
Let’s focus on the reimbursement motive. Reimbursement rates for Medicaid and Medicare are held ridiculously low because the Feds can’t control utilization. And if providers treat too much, the Feds slash reimbursement, which causes providers to deliver more services to make up for the revenue shortfall, and the vicious cycle continues.
To “fix” the problem of low reimbursement, Gov. Perry will tax hospitals,
who will pass along this cost to their insured populations,
who will have to raise premiums to cover the additional cost,
thereby making insurance even less affordable,
causing more employers to drop insurance,
increasing the number of uninsured,
who will still need medical care,
but since they can’t afford it and don’t have insurance, will get it for “free”
from providers who will then have to charge their insured patients more,
accelerating the death spiral.
And that’s why Gov. Perry’s reform is a really bad idea. It doesn’t solve a problem, it makes it even worse.
Note – those of us with insurance are already paying over a thousand bucks a year in higher premiums to cover the costs of the uninsured.
Thanks to Anthony Haley for the head’s up.
Texas Governor Rick Perry has demonstrated leadership by opening up the dialogue on the uninsured at the top levels of Texas government. It’s one thing for us advocates to jawbone about it and another for the Governor to do so. The legislature is in session and will be more likely to address the issue once Governor Perry formally raises it in his State of the State address. I have never seen a major health care proposal sail through with total acceptance, or come out of the sausage grinder the way it went in. The discussion has to start somewhere, and the Governor’s bully pulpit is a pretty good place to begin.