I’ll Tell You What the Rush Is

The Chicago Tribune urges Senate and House leaders to slow their headlong rush towards a poorly considered healthcare reform bill:

House and Senate leaders are pushing health-care reform at breakneck speed, hoping to produce a bill for President Barack Obama to sign by the end of the year, perhaps as early as this fall.

The House is putting the finishing touches on its gargantuan bill. The leaders vow to unveil it this week.

Meanwhile, the Senate is sorting through a dizzying array of new taxes and fees to pay for its version of health-care reform.

The White House is twisting arms and making side deals with the hospital industry, drugmakers and Wal-Mart. The administration is trumpeting billions in promised savings to finance this massive expansion. But it’s hard to understand exactly who has agreed to what and how all these alleged savings are supposed to materialize.

What’s the rush? When did reforming the $2.5 trillion-a-year health-care system become a sprint?

I’d be happy to help the Tribune editors out on this one. First, we genuinely need a sense of urgency in reforming our healthcare system. According to the CBO by 2012 the “Medicare trust fund” will be taking in less in revenue than it needs to pay out for the services that will have been provided to Medicare recipients. Since by law the Medicare trust fund consists of a stack of IOU’s from the U. S. Treasury that means that legislators will have the unappealing alternatives of spending less on other things they’d like to spend on, taxing more, or borrowing more, probably under less favorable circumstances than prevail now. Unfortunately, the direction in which we’re heading will do little to change the situation in 2012 and it will almost undoubtedly render those unappealing alternatives even less appealing than they otherwise might be. That doesn’t mean, however, that there isn’t a real problem that must be addressed instanter.

Additionally, as the New President smell fades and President Obama is forced to make choices, choices that necessarily will aggravate somebody, his popularity is beginning the slow decline which like most presidents will probably characterize the remainder of his term. Congressional Democrats will never be in a better position to enact the bill they really want than they are right now.

I’m rather surprised at how narrowly the issue of healthcare of reform is being considered. The bills presently making their way through Congress are completely directed at what’s called “universal coverage”—ensuring that as many people as possible have healthcare insurance. I think that’s something of an exaggerated problem. The 46 million uninsured include illegal immigrants (whom nobody claims to plan to insure) and “free riders”, people who can afford healthcare insurance but elect not to. Cost control is little more than wishful thinking and, as I mentioned above, it’s a truly pressing problem. Additionally, reducing costs makes everything easier; if costs get high enough nothing will be easy.

But although those are the only problems being discussed those aren’t the only problems with our healthcare system. Let me mention just four of the many problems in serious need of being addressed.

First, the number of Americans who live in “medically underserved communities” is estimated to be between twenty million and a whopping ninety-six million. What that means is that even if they had insurance they couldn’t get adequate medical service because there just isn’t enough healthcare service near where they live.

Second, the United States has the lowest number of primary care physicians per 100,000 population of any OECD country despite the reality that more primary care is closely correlated with lower cost and better outcomes. Universal coverage will just aggravate this problem in the United States.

Let me give you an example from my own life. I have good healthcare insurance, the most expensive option available. If I have a medical problem that needs addressing and I call my primary care physician’s office, I can get an appointment six weeks out. Need attention more quickly? I’m told to go to the emergency room. I’m not unique in Chicago.

Third, we’re importing a large number of doctors from other countries, particularly developing countries, and that’s simply unconscionable. Those docs are badly needed in their home countries. I don’t blame the docs. At the very least we should be reimbursing the home countries for the cost of their education which is frequently paid from the public purse.

Fourth, nobody is really happy with our current healthcare system. Our outcomes are lousy compared with other OECD countries. Patients and their employers think that healthcare is too expensive. Physicians think they aren’t paid enough, work too hard, and spend too much time on paperwork. There really must be a better way. Especially considering the kind of money being spent.