In anticipation of President Obama’s 28th speech on healthcare, the Washington Post’s editors offer him some advice:
MAKING SURE that anyone who is sick can receive treatment is, it is often said, a moral imperative for any civilized country. We agree. But here is another moral imperative: ensuring that America’s adults do not incur so much debt that they choke off economic opportunity for the following generation. The potential conflict between these two imperatives is one reason President Obama’s mission tonight — rescuing health-care reform — is so challenging.
Believe it or not, of the two tasks — providing universal health care and controlling government red ink — the former is easier. There’s more agreement on the essentials than the volume of debate might lead you to think: Mandate that every American buy insurance and provide subsidies, on a sliding scale, to those who don’t get insured at work and can’t afford insurance on their own. Insist that insurance companies, as a reward for all these new customers — many of them young and healthy — accept anyone who wants to sign up, regardless of prior health conditions. Tax employers who don’t offer insurance so as not to penalize companies that do. Establish exchanges in which competing insurance companies offer plans that customers can easily understand.
Much of the advice they proffer echoes themes I’ve been sounding here. The one item I’d disagree with is their puzzling devotion to an administrative board to decide reimbursement levels which has been termed a “Medpac on steroids”. The notion that any body composed of human beings will operate “without political interference”, the idea that prospective effectiveness can be determined at a distance, and the peculiar belief that a federal bureaucracy will manage a sixth of the economy efficiently all defy experience.
I suspect the devotion is due to their belief as well as that of the prevailing wisdom that the WP represents and that of the Obama Administration as well that cost control can be achieved with such a committee. It will prove a forlorn hope as long as all of the incentives push towards increased costs, that won’t change without systemic change, and the bills currently making their way through the Congress don’t effect systemic change.
If I could give advice to President Obama, I’d urge him to establish relative priorities in healthcare reform. Distinguish among needs, wants, and likes. I think that providing healthcare for the poor and the elderly, especially the elderly who can’t work, are “needs” and that they will only continue to be possible if we reduce costs. Expanding coverage, especially for those who can’t obtain insurance at any price, is something more like a “want”.
As best as I can tell the bills making their way through the Congress place likes and wants ahead of needs. That shouldn’t be acceptable to anybody.
I find reading the explanation of how universal health care is the easier task to be sobering. No doubt true, but there is a lot of potential pain in there, and if the insurance regulations increase premiums, then a whole lot of people are going to be complaining that they are worse off than before.
That’s why I think that anything short of systemic change is a cruel hoax.
The more I think about it, the more I believe the public option is intended to be the safety valve for when they explode the private insurance industry for the bottom three quintiles of the economy.
I think this is quite reasonable. Probably because I’ve made the same argument myself: without reducing the costs the rest of this health care stuff just wont matter, not for long anyways.
Since it is reasonable such advice will be studiously avoided. Instead the “michael reynolds mindset” will prevail: if we make it a right, then the money will magically appear.
And how will we magically provide care for those who do need it without increasing costs? Competition? Magic until we have a model that works. Increasing the number of providers per Dave? Magical thinking until we prove it. There are models which have proven that you can give good care and have lower costs. Those do not seem to be among the choices.
Steve
steve…uhhmmm…yeah. Are we all in agreement? Lower costs, then look to increasing health care coverage?
Damn, this could be a first…agreement in a blog’s comments section.
Proof positive that the reform that’s enacted into law will try to increase coverage and won’t lower costs.
LOL, I have always said costs first, then portability, then coverage. Where we disagree is on how to lower costs. I think we also agree, kind of, that lowering costs is not politically feasible for a first term president since it means addressing Medicare.
Steve
Interesting, so you think his health care reform this term should be more modest and should save the cost cutting aspect till later, assuming he is re-elected?