I’m reading all sorts of different predictions about what will be in President Bush’s State of the Union address this year. Of course, Iraq and “the surge†will be a topic. Some are saying that immigration reform will be the main topic. Others are all atwitter that healthcare reform will be at the top of the heap.
I’m a little surprised at the vehemence with which universal coverage is being pressed these days. Note that universal coverage, single payer, and a British National Health-style system are three different things.
The Massachusetts and California plans seem to be mostly targetting universal coverage and it will be interesting to see how they perform. I suspect they will have the perverse effect of increasing costs.
That’s almost inevitable: if you have more people consuming more services without an expansion of the supply of services prices will rise. I presume that the hope is that by enabling people to use relatively less expensive pediatricians and internists as primary care physicians rather than relatively more expensive emergency rooms it will tend to control costs.
That was the idea behind TennCare and it succeeded in that: people covered under the plan used emergency rooms less. However, Tennessee has kicked the system out because costs were out of control.
Single payer is (to my mind) a meat-axe approach to achieve cost control by cutting insurance companies out of the picture. It’s a one-off and can only achieve a 10-15% reduction in costs best case. At the present rate of increase that savings will be absorbed in a couple of years. That’s not enough of a savings to stave off the meltdown that’s ahead of us.
Practically nobody is pitching a BNH-style program. When people talk about an emerging consensus on healthcare this isn’t it.
So why the vehemence? I can only guess that there’s an alliance among employers who want to get employee and retiree healthcare costs off their backs, folks who want universal coverage for “social justice†reasons, folks who believe that single payer will solve more problems than it actually will, folks who want a BNH-style system for reasons I won’t even guess at, and people who just want to pay less for healthcare.
The goals of these groups are so different I can’t imagine the alliance being too durable.
