The feel-good talk about health reform – covering all Americans, reining in those nasty insurance companies, improving health through prevention and wellness – has all but ended, replaced by reality – as presently conceived, reform is unaffordable.
Now, PR firms are asking bloggers to encourage readers to sign petitions decrying taxation of health benefits, specialty medical societies are fighting to hold onto their high reimbursement, lobbyists for imaging companies want expanded coverage of MRIs (!?), employers are getting increasingly uneasy and budget hawks are amping up the volume.
As I’ve said for months, comprehensive health reform is a doubtful proposition.
Everyone wants universal coverage, but no one wants their taxes raised or their share of the pie cut.
While the latest polls indicate some willingness on the part of Americans to accept somewhat higher taxes to help fund universal coverage, on the expense side of the ledger there is precious little evidence of belt-tightening. Sure, pharma volunteers to cut $80 billion over ten years (remember the current annual health expenditure is $2.2 trillion); that’s a mammoth two-tenths of one percent.
And yes, we all recall the health care/union execs who promised to cut $2 trillion from the nation’s budget over ten years – and then stumbled over each other as they backpedaled away from that ‘promise.
The draft of the Baucus bill is a clear indication that some of the Senators ostensibly driving the health reform process have very little appetite for taking on the health care industry; the bill is all about coverage with almost no meaningful effort at controlling cost.
And this from the Chair of the Senate Finance Committee. The bill that emerges from the HELP Committee has the weight of Senator Kennedy behind it; that said early indications are it does not exactly take the long knives to spending. Kennedy may be the best hope; in a Nixon-goes-to-China way the ailing Senator has the political weight to win cost concessions that Baucus et al are avoiding like the plague.
As Bob Laszewski has been assiduously noting, all the happy talk will amount to naught if the CBO and OMB can’t find meaningful spending reductions.
Without a significant reduction in projected health care spending universal coverage is unaffordable. Fortunately OMB and the CBO are watching our pennies.
So, what could happen?
There are at least three potential results.
President Obama has proven himself capable of achieving the seemingly impossible. Think on this – which is more unlikely – America electing a black man to the Presidency or passage of health reform? Do not discount his ability to deliver.
Incremental reform has already occurred – SCHIP is but one example; there is also a bill before Congress to reform Medicare’s physician reimbursement process; ending medical underwriting and requiring community rating would dramatically alter the insurance system (leaving aside the problem of community rating without universal coverage, which should be inextricably linked). Big changes in drug and device approval and reimbursement are also likely, and hospital reimbursement is already on the chopping block. In any other environment, any of these changes would be big news. Together, they make for the biggest change in health since 1964.
There remains one plan that reduces cost, covers everyone, and already has bipartisan support – the Wyden-Bennett Healthy Americans Act.
I’ve long supported this bill, and believe it is our best chance for meaningful reform that addresses cost and coverage.
Jun
22
Joe– As you remind us often, it is all about the money. It cost no one a dime to elect Obama, but it will take a good many dimes out of everyone’s pocket to reform healthcare. No one will get away scot-free. We cannot plunk this one on the deficit. People are finally beginning to notice that debt is about to crush us all. The alternatives to more debt to pay for healthcare are substantial tax hikes– taxes that hurt– payment reductions– at a time when hospitals and clinics are already closing– and more disruption– at a time when the economy is already doing a good job of capsizing. Whatever the merits of the various proposals and the ways in which they distribute the pain, there is little appetite for more pain right now. The body politic, and that’s all of us, can only handle so much uncertainty and, yes, so much change at one time. I think we are already there and meaningful reform is just going to have to wait until we have all digested the current ration of turmoil.
This is so frustrating to me. I live in Massachusetts, and Senator Kennedy is on board. I think that Kerry would follow suit. I’ve already written to my Representative. I have no idea what I can do. If I lived in Maine still, I’d push Snowe and Collins hard, but I don’t.
It is important for us consumers to remember that we also have a role in healtcare reform. We need to take ownership of our health and help to personally drive down the cost of care. It would be great to see an alignment of three vectors focused on curbing the healthcare costs : 1) The Consumer, 2) Government 3) Private Healthcare industry. The power is in the three mobilizing to improve health and contain costs.
Since day one, I’ve repeatedly asked the following question: how on Earth are we as a country going to pay for this? At some point, the people of the United States (and I pray, politicians) will come to the amazing conclusion that the treasury of our country is not an endless ATM machine. The supply of money is finite. And at some point, the foreign holders of US debt will make this point clear.
Senator Kennedy and others like him can fantasize all they want about helping everyone. But until stakeholders from all sides realize that it’s in everyone’s interest to get serious about the crushing costs of trying to assure healthcare for all, any attempt to enact legislation will either fail or worse, mandate a system that could end up costing all Americans more, reduce the quality of healthcare we expect, and potentially bankrupt the country.
Lost in all the rancor and discussion is a simple demographic truth: America is getting older, and quickly. The population bulge that is the baby boomer generation is rapidly careening toward retirement. In 30 years, many of the people generating income and paying taxes now will be retired, in need of greater healthcare services and drawing down from the economy. ANY Kennedyesque Camalot healthcare dream that fails to take this simple truth into account could doom our country to financial ruin.
As proof, I offer the State of California. The (formerly) Golden State has the most robust economy of any state in the Union. Yet, California is on the verge of bankruptcy. Why? Entitlements. The simple truth is that the state of California spends far more than it takes in. Voter propositions and legislation have baked in permanent expenditures for the taxpayers of California, piling on layer upon layer of crushing debt. The result: paradise lost.
Please understand, I want to see healthcare reform as much as anyone. But until we clearly understand how to finance this ambitious idea without resorting to smoke-and-mirrors, we’re better off either rolling out change through incremental improvements or waiting to get this right. Measure twice, cut once.