I find myself in the somewhat uncomfortable situation of being in substantial agreement with Zeke Emanuel (brother of Rahm and Ari the Hollywood agent). Democrats are having the wrong debate about health care. From his New York Times op-ed:
Democrats are deeply concerned about achieving universal coverage. The simple way to do that is not through a single-payer Medicare for All plan, which faces daunting political opposition. Instead, they can get coverage for most of the remaining 28 million or so Americans with auto-enrollment. Changing some existing policies, like harmonizing the income eligibility standards for Medicaid and the insurance exchanges, would enable the government agencies, hospitals, insurers and other organizations to enroll people in health insurance automatically when they show up for care or other benefits like food stamps.
For the other 295 million Americans who have some form of health insurance, the problem is high costs. Even with health insurance, high premiums, deductibles and co-pays, surprise hospital bills and exorbitant drug prices inhibit people from accessing care and taking their medications, threaten to drain their savings, or even force Americans into bankruptcy. Democrats need a plan to deal with this problem.
He proposes four strategies for managing health care costs:
- Negotiate for pharmaceutical prices
- Cap hospital prices
- Standardize insurance billing
- Accelerate the transition from fee-for-service to value-based alternatives
I’m in material agreement with him on the objective. Indeed, I’ve been saying that the push for universal coverage was largely misplaced because lower costs will make universal coverage easier but not vice versa. I remain unconvinced by three of his four cost-saving proposals.
It’s understandable that Democrats would place their focus where they have. Insurance coverage and care tend to be popular. Controlling costs isn’t for a simple reason: one person’s expense is another’s revenue. Controlling costs inherently means controlling wages. And as G. B. Shaw put it when you rob Peter to pay Paul you can always depend on the support of Paul.
In the early discussion of the ACA, it was pointed out by someone that of the 45 million (est.) without insurance, only 15 million needed it. These were the working poor. For the rest, about half were rich people who could pay their own way, and half were young, healthy adults who only needed some sort of catastrophe insurance. The 15 million needy could have easily put into Medicaid.
So, why did ACA fail? It was supposed to cover everyone. Why are there 28 million uninsured? Surely that deserves some study.
Simple. No system registers everyone. Not France’s. Not Germany’s. Nobody’s. I think that’s the point of Dr. Emanuel’s point about coverage. Enroll at the point of service.
Costs should drop soon anyone. Trump says we are curing cancer, the childhood version.
“During the rally at U.S Bank Arena, he said: “The things we’re doing in our country today, there’s never been anything like it. We will be ending the AIDS epidemic shortly in America, and curing childhood cancer very shortly.” ”
I can only hope people realize how stupid that statement is compared with reality.
Steve