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.