As if in answer to my questions a group of centrist Democratic senators plus independent Sen. Angus King, have produced a list of changes they’re proposing to the PPACA. Their proposed changes are:
- More alternative plans.
- Startup funds for “consumer-driven health insurance cooperatives”.
- Direct states to develop models for sale of health insurance across state lines.
- Raise the employer mandate to companies with more than 100 employees rather than 50.
- Extend the availability of health insurance tax credits for small businesses and make them available to companies with 50 or fewer employees rather than the present 25.
- Streamline reporting requirements (unspecified).
- Allow individuals to enroll in insurance programs directly through insurance companies on a permanent basis.
That raises two questions for me. First, what’s wrong with the PPACA? Second, do the senators’ proposals correct those? I don’t see it but it’s possible I have blinders on. As I see it the PPACA’s main problem is that it insures too few people for too high a cost and I see nothing in the senators’ proposals that will correct either of those problems.
I don’t oppose the PPACA. I want it to be fully implemented as soon as possible so that we can turn to the pressingly urgent problem of reforming healthcare in the United States rather than the distraction of reforming healthcare insurance. Our primary problem is that healthcare is too darned expensive. Eventually people will figure out that one of the fundamental assumptions of the PPACA—that people want healthcare insurance—is wrong or, at least, overstated. The uninsured are indifferent at best to healthcare insurance. They want healthcare to be available at an affordable cost.
Costs are an urgent problem for state and local governments which can’t wait any longer. Here in Illinois as I suspect is the case in many states we spend more on healthcare than on education or anything else on which the state spends money. The cost of healthcare continues to rise faster than revenues and faster than revenues should be expected to increase.
The senators who’ve made their proposals represent the far right among mainstream Democrats and given the state of the party leadership I’d be surprised if their proposals go much farther than being something to campaign on. It may be that I’m wasting my bandwidth even discussing them but so, I believe, are those who think that meaningful reform of the PPACA is likely for the foreseeable future.
Has anyone seen a “baby boom rat through the snake” analysis of what the rate of health care expenditure would look like without this demographic bulge?
The baby boom has affected every aspect of economic life for the past 60 years. No reason to expect health care services to be any different.
We’ve known that that Baby Boomers would get old for approximately 70 years now. It was well known in 1965 when Medicare was first enacted into law.
What they didn’t predict was that the cost of healthcare would grow so fast in real terms, far faster than incomes, far faster than other costs.
The measures we could take to rationalize healthcare spending are:
1. Stop favoring insurance over health care. Recognize that health insurance has as little to do with health as life insurance has to do with life.
2. Force all healthcare providers to publish all rates for treatment bt ICD-9.
3. Encourage Medical Tourism, i.e., treatment in Mexico, Costa Rica, Argentina, India and Thailand, where the costs are as much as 90% lower.
3. Eliminate tax-favored status of health insurance over health care on a cash basis.
4. Eliminate all licensing of healthcare providers, medical instrument developers and drug companies, as Milton Friedman proposed.