Views Worth Considering on Healthcare Reform

I think that the views expressed here by Keith Hennessey are more worthy of consideration than the views of either House Democrats or House Republicans:

The president is correct that health care reform is essential to a strong economy. He accurately identifies the underlying problem as extraordinary growth in health spending, leading to slower wage growth, too many uninsured and unsustainable government spending. He is correct that reform needs to “bend the cost curve” downward to stop families, employers and governments from chasing their own tails. Unfortunately, the legislation being developed in Congress moves in the opposite direction.

After the vice president admitted the administration had misread the economy, the president said administration officials, instead, had incomplete information — but yet they would not have done anything different in the too-slow stimulus. We need to prevent a recurrence of the stimulus mistake on health care.

The position that House Republicans are seemingly taking, opposing any kind of reform, is untenable. In my view they should be getting behind some minimally acceptable alternative and supporting it with all their hearts and souls. Nothing will come of nothing.

The House Democrats are equally wrong:

Congressional Democrats propose partially offsetting short-term spending increases by cutting Medicare payments to providers. We need these spending cuts to solve the fiscal imbalance in current entitlement programs. If they are, instead, pilfered to offset an entitlement expansion, then the only long-run solution left to address Medicare and Medicaid spending is higher taxes.

Democrats are arguing among themselves about which taxes to raise to cover the rest of the short-term spending increase. Union pressure is taking repeal of the tax exclusion for employer-provided insurance
off the table, leaving Democrats to debate the relative merits of tax increases on high-income individuals and successful small-business owners, capital gains, donations to charities and soda pop. In addition, states would be allowed to tax health insurance premiums up to 3 percent to pay for new bureaucracies.

Since each of these taxes would grow as fast as the economy, while the new spending will grow much faster, the long-term result will be both higher deficits and an ever-increasing tax burden.

We need more dramatic reform. Congress should start by replacing the current tax treatment of health insurance with a standard deduction or a flat tax credit like that in the Ryan-Coburn bill.

While I agree with Mr. Hennessey that more dramatic reform is necessary, I don’t completely agree with him on the nature of the reform.

It’s far too late to get government out of healthcare. That ship sailed with the passage of the Pure Food and Drug Act of 1906 and was completely scuttled with the enactment of Medicare and Medicaid more than 40 years ago. The alternative that’s left is prudent stewardship and, unfortunately, prudence is in very short supply.

All of the reasons that Medicare was enacted are as true today as they were in 1965. Very few of us are or will be fortunate enough to be healthy enough in our old age that we won’t need healthcare or to save enough that we can pay for the healthcare we’ll need after we’re too old to work. We need to achieve a balance between frugality and profligacy rather than pretending the need doesn’t exist.

So, means test Medicare? Sure. More thoughtful oversight of Medicare? Of course. Eliminate it or starve it? I don’t believe that would be prudent.

5 comments… add one
  • Brett Link

    To be truthful, getting the government out of health care (assuming you want to do that, and I’m not necessarily in favor of that position) was pretty much impossible from the point where they mandated emergency care for everyone regardless of ability to pay. You’re never going to get even close to a free market with that in place, and I don’t see many takers arguing for its removal.

    Union pressure is taking repeal of the tax exclusion for employer-provided insurance
    off the table

    The Unions probably won’t support a removal of the tax credit for anything short of universal, single-payer health insurance.

    On a side-note, it’d be interesting to see a breakdown of all medical costs, and see how they proportionally fall with regards to people on Medicare. Sure, it’s expensive, and probably unsustainable short of tax increases, but if the elderly are already the costliest segment of society in terms of health care, then you’re just not going to be able to get many cost savings short of either a massive increase in supply (and I mean massive) or a change in paradigm on what to provide the elderly (not necessarily in terms of letting them die).

  • Offer elderly patients a choice: coverage and care as it now exists.

    Or a .45 and a single bullet. In exchange for which half the cost of what would have been their care will go as a cash payment to their family. Less pain, more gain, and we all save a fortune.

    Hey, I’m trying to help.

    And by the way, Soylent Green? It’s people.

  • Getting government out of health care isn’t going to happen, sure. However if you look at countries that have the better health care, slowest rising health care costs, and so forth they tend to have a far more market oriented health care system. France, the Netherlands, and Singapore are examples that come to mind. In fact, the last one is one that might be the rarest of them all…a sustainable health care system.

    However, the singaporean system mandates savings. It forces you to do it. Failure, severe punishments (remember this a country that put the Nanny in Nanny state–mandatory public toilet flushing laws, chewing gum ban, etc.). That public cigar smoking Michael would probably get you canned there.

    Getting government out isn’t going to happen, but putting in more market oriented, price mechanism driven processes is probably about the only way this will work. Anything else and you are looking at something like either the Canadian or British systems where people do their own dental work with needle nose pliers.

  • Brett Link

    I’m not sure I would call the French system a “market-oriented” health care system – it pretty much covers everything above a certain cost (including the most expensive procedures) or percentage of cost (If I recall correctly, they pay 80% of the cost on all but the most expensive and necessary treatments, in which they pay the full price).

    Nor the Netherlands, for that matter – the Netherlands is a combination of mandatory private insurance for short-term treatments, with a state-run mandatory insurance program for long-term treatments.

    I could live with the Singaporean system, which basically combines universal catastrophic health insurance (Medishield) with mandated health savings accounts (Medisave) and subsidies (Medifund), but calling it a “market-oriented” system is a stretch. Moreover, it’s funded by a mandatory contribution of 6-8% of income to Medisave – I question whether you could actually set that up in the US.

  • I didn’t say market oriented now did I? I noted that they are the more marekt oriented systems relying on the price mechanism and consumers bearing a portion of the costs.

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