That, in a phrase suitable even for twitter, is the future of health care reform.
We can afford universal coverage – if we cut provider costs drastically, through reduced prices, reduced services, or more likely, reductions in both. So far, no one, and I mean no one, with any political power has even broached this subject.
Or, our elected officials can decide to avoid the lynching that would follow immediately after they start talking about slashing provider reimbursement, and instead decide to just pass universal coverage-based reform now and worry about paying for it later. This has worked really really well for past Congresses and Presidents, so what the hell?
As for budgeting money to pay for reform, as Bob Laszewski has pointed out, the $635 billion President Obama has allocated won’t be near enough; and even that figure is highly dubious.
One option that will not get serious consideration (I can feel the anger coming thru the ether already) is single payer. Sure, it would solve a lot of problems, but it just is not going to happen in the US. Never ever ever. Politics is indeed the art of the possible, and single payer is just not possible. Accept that and move on.
So we’re stuck on the very long and very sharp horns of a dilemma, or more accurately, Congress and President Obama are.
Does anyone believe Congress has the intestinal fortitude to cut reimbursement, no matter how that ‘cut’ is described/presented/packaged? Anyone?
We know that there is a cabal that is in favor of ignoring the red ink and just passing universal coverage, with the assumption that the $1.6 billion spent on comparative effectiveness will cut medical spend by, oh, say, $600 billion per year a decade from now. But thankfully that group of irresponsibles are getting little traction.
I just don’t see health reform happening anytime soon – with ‘soon’ defined as within the next few years. I don’t like it, you don’t like it, no one likes it. But that’s reality.
That doesn’t mean I won’t keep hoping it will happen, and working towards that end.
Apr
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Universal covergage may be more politically palatable than single payer, but both perpetuate the single biggest driver of healthcare cost: that the consumer of healthcare is not the purchaser of healthcare. If you took any other product or service in our economy, and allowed people to purchase it while someone else paid for it, the costs of that product or service would skyrocket. Universal coverage can only contain cost by controlling price and rationing service, as you explicitly state above. CDH is the right direction.
Several things, there is so much being attempted right now, that we may not do anything very well, let alone understand the core problems. Secondly, we need to proceed with Healthcare in a way that we understand the core issues; my concern is that we will end up like Mass. because we need to do something – anything! However, something times doing something just to do something makes things worse. Now is the time to “seek to understand,” and come up with a tiered process for implementation. Oh, and realize whoever is implementing the plan will be hated and targeted by everybody.
As Machiavelli said,
The innovator make enemies of all those who prospered under the old order, and only lukewarm support is forthcoming from those who would prosper under the new. Their support is lukewarm partly from fear of their adversaries, who have the existing laws on their side, and partly because men are generally incredulous, never really trusting new things unless they have tested them by experience. In consequence, whenever those who oppose the changes can do so, they attack vigorously, and the defense made by the others is only lukewarm. So both the innovator and his friends come to grief.
(Niccolo Machiavelli, The Prince, 1513)
CDH is the only real way to get a new quality American Healthcare system. The efforts in Washington should be focused on how to place competition in the mix, not a new government ran insurance program that competes with the private sector.
For those that want a single payor system, the thought of a UK or Canadian system is just scary. The UK has more problems than the US, and we are marching towards socialism just as Europe has been there for awhile.
Get the government back to what it is best at, an overseer of a fair playing field in the capitalist system. Competition, is what made the country. There are ways to do it, and lead the way with CDH. Universal Access is worth the effort, but the government going down a path of offering its own “insurance” plan is just not smart and will be regretted by generations to come in my humble opinion.