I didn’t work it into my earlier post this morning on Illinois’s awful fiscal situation but, as I’ve mentioned before, much of the state’s problems are due to the excessive costs of healthcare. Doing anything about this is beyond the state’s power. Even if it’s upheld by the Supreme Court the PPACA will only aggravate the states’ problems by dumping higher Medicaid expenditures on them. That’s a big reason for the states’ AGs filing the case that’s before the SCOTUS now.
More on this in a later post.
It’s ridiculous that Medicaid even exists. It and the VA should be folded into Medicare and made a national program rather than being alowed to impact the limited funds available to states. The PPACA was always on the wrong track because it addresses the wrong problem: we have a healthcare crisis in this country, not a health insurance crisis. Obamacare treats the symptom and not the cause.
Some 45 years back when Medicare was enacted I argued that care for the poor and, particularly, the elder poor should have been handled like the VA, i.e. with facilities operated by the government and staffed by personnel who were government employees. That, of course, would have been socialized medicine unlike our present situation in which 70% of healthcare is funded by government at one level or another by one means or another.
The problem we have now is that, due to nearly a half century of subsidies, healthcare in the U. S. is something between 30 and 50% more expensive than it should be and there’s no real commitment to rolling those costs back. Those who believe that a European-style system naturally produces lower costs are kidding themselves. A system committed to cost control (regardless of how its organized) produces lower costs.
The cost-control measures common to those countries which have managed it seem to be non-proft insurance companies, standardized services and a payer powerful enough to negotiate prices. Within those parameters there’s a pretty broad playing field for what form a health-care system takes. For example Germany keeps doctors’ incomes suppressed in exchange for their graduating from medical school without the massive debt overhead, while Taiwan did away with the fee-for-service model entirely. Japanese health care providers are all private while the cost of their services is identical throughout the country (the government publishes a list of prices to the public every two years so that people know exactly what they are getting for their money).
You’re exactly right: if we wanted to control costs, we would. We don’t because a lot of people are getting very wealthy thanks to the system we currently have. There’s a benefit to making government big but stupid: it’s easier to manipulate.
Yeah, that’s pretty much the way I see it. There’s something of a time inconsistency problem that those who are crying loudest for a single payer system aren’t taking into account.