The Only Way Health Care Reform Can Work
Once again, our federal government is wading into the murky swamp of health care reform, and once again appears destined to get lost in the swamp. As expected, neither side is willing to play it straight with us. The Democrats refuse to be honest about costs while Republicans offer nothing but obstructionism and insincere gimmicks such as "health savings accounts", which effectively amount to a mirage of health care coverage that lasts right up until the point where one gets sick and there's not enough money in the microscopic account to pay the medical bills. We're stuck in the untenable position where doing nothing is scarcely an option but every proposal on the table would almost certainly make the existing cost structure of health care policy even less sustainable.
The first thing we need to do is to admit that illegitimacy of three myths being advanced by supporters, and even some detractors, in the health care debate.....
Myth #1. "Unhealthy lifestyles" cost the health care system additional dollars. Of the three myths I'm listing here, this is the most commonly accepted by all even though the diametric opposite is true. The inverse, "healthy lifestyles", result in longer life expectancies....and longer life expectancies lead to higher health care costs. It's an inconvenient truth for politicians who are invested in the "healthy lifestyles save money" mirage as a pretext to justify herculean sin taxes against the "unhealthy", their preferred path-of-least-resistance revenue windfall to put money in their pockets today even though it will result in massively higher costs tomorrow. This pyramid scheme willfully fails to acknowledge that end-of-life costs constitute an ever-escalating percentage of overall health care costs....and that the older one lives, the higher their end-of-life costs run. The aforementioned hyperinflation of sin taxes against "unhealthy lifestyles" are ethically indefensible even without acknowledging that those who pay them run up health care costs lower than the "healthy" by double-digit percentages. Financially disincentivizing "unhealthy behavior" with sin taxes, despite its popularity with the arithmatically clueless, will only serve to accelerate the bankruptcy of the existing health care apparatus.
Myth #2. "Preventive health care" practices save money. Preventive health care is without question best medical practice, but in no way would it save money. The premise is that if more people receive extensive testing for conditions that may arise in the future, it will be cheaper to treat if it's detected early than if they later get sick and require more costly medical procedures. It sounds perfectly reasonable, but the only problem is that for every person testing positive for the condition they're being tested for, there are likely to be 99 others who test negative. The cost of testing 100 healthy people easily outweighs the cost of treating one sick person. Again, preventive care is wise medicine, but it's unwise from a cost-control perspective.
Myth #3. There will be no "death panels". The Republicans were politically shrewd to invoke the "death panel" language in the midst of a national health care debate because the rationing of costs will be the only way we can stop a national health care plan from going bankrupt in the course of 20 years. As disingenuous as it is to see these recently converted Medicare enthusiasts in the Republican Party stake out a position that effectively marries them to unlimited spending on every Medicare recipient who wants Cadillac end-of-life treatment, the GOP is clearly calling the Democrats' bluff here. Since the fastest-rising cost of health care is end-of-life care, it's a painful truth that the party in power when health care reform becomes reality will have to start telling seniors on Medicare "no" on expensive treatments and prescriptions designed to keep them alive another two months. It's common practice in Canada, Britain, and every other nation with national health care plans. And it would have to be common practice here or the cost curve for ObamaCare would quickly head off the same financial cliff that Medicare is now.
If I'm a senior, health care reform done right is all pain and no gain for me. While I generally respect seniors, the reality is that those over age 65 already enjoy a socialist utopia even though in an age of rising life expectancies and a swelling of their ranks, maintaining a socialist utopia for this demographic is the least financially possible. Something's gotta give, and for me it's an easy choice. With 47 million working age Americans uninsured and being denied basic medical coverage outside of catastrophic care in emergency rooms, seniors have some nerve to say their children and grandchildren should continue to be denied basic public health care coverage while their own public health care coverage should be limitless. As the Baby Boomers continue to retire in ever-rising numbers, expect a political realignment divided on generational lines fighting for limited public resources. If we think the debate is ugly now, it's gonna get far worse.
But getting back to the current health care debate, my preferred plan is of course the plan that is politically off the table....a single-payer plan with cost rations (i.e. death panels) much like every other civilized economy in the world with a far more efficient health care system than ours has. Absent that, the least terrible option that is on the table is Obama's "public option". His marketing of the public option as "paying for itself" is of course delusional. Several of the plan's critics are correct in their objections that private insurers would dump high-risk customers and thus force the sickest demographic of Americans onto the public plan, with exploding costs. Nonetheless, once established, the public option's inevitable cost-control failures would almost certainly trigger a further transition into the preferred single-payer plan I cited above. It'll be messy, and costs will go dramatically up before they go down despite Obama's irrational rhetoric to the contrary, but a generation from now we most likely would be in a position to "bend the cost curve downward".
Of course, the least terrible option of a public plan is very quickly headed off the table, and it looks like the "health reform" we will end up with is the most terrible option....a multitrillion dollar taxpayer subsidy to the existing insurance industry labyrinth that will allow their unsustainable health care cost structure to spiral even further out of control, only now using taxpayer money along with fast escalating customer premiums to do so. The best analogy to liken what this brand of "health care reform" would amount to is financial aid to private colleges. Tuition at private colleges rises at about four times the rate of inflation every year as a direct result of the majority of their students getting taxpayer-subsidized tuitions, with average tuition rates at more than $30,000 per year and with no end in sight. Similarly, if we think our health insurance premiums are high now, just wait until the insurance companies are assured to ever-rising taxpayer giveaways financing their operations.
Furthermore, I have a major ethical problem with the idea of mandating that currently uninsured Americans pay Big Insurance a premium for a "collective pool" that, given the youthful demographics of most of today's uninsured, will almost certainly be consumed by people older and wealthier than themselves. The health reform plan that passes is very likely to have this mandate, which amounts to yet another financial assault against lower-income Americans on top of the mountains of new "sin taxes" disproportionately clobbering them already.
I would almost prefer we limp along with our current broken health care system a few more years than to pass the "compromise" plan likely to be signed into law next month which would make the current system dramatically worse. If this passes, we'll have to revisit health care reform a few years from now anyway because of the explosive growth in costs that always comes when massive taxpayer subsidies to private companies allow them to operate outside the parameters of market forces. Regrettably, it'll almost certainly be too late before this country gets serious about controlling health care costs and moves past the aforementioned myths that contribute to the cost escalation. Bottom line.....somebody needs to start telling seniors "no" sometimes or the system will be brought to its knees. Nobody is willing to talk about that. But they have to.
The first thing we need to do is to admit that illegitimacy of three myths being advanced by supporters, and even some detractors, in the health care debate.....
Myth #1. "Unhealthy lifestyles" cost the health care system additional dollars. Of the three myths I'm listing here, this is the most commonly accepted by all even though the diametric opposite is true. The inverse, "healthy lifestyles", result in longer life expectancies....and longer life expectancies lead to higher health care costs. It's an inconvenient truth for politicians who are invested in the "healthy lifestyles save money" mirage as a pretext to justify herculean sin taxes against the "unhealthy", their preferred path-of-least-resistance revenue windfall to put money in their pockets today even though it will result in massively higher costs tomorrow. This pyramid scheme willfully fails to acknowledge that end-of-life costs constitute an ever-escalating percentage of overall health care costs....and that the older one lives, the higher their end-of-life costs run. The aforementioned hyperinflation of sin taxes against "unhealthy lifestyles" are ethically indefensible even without acknowledging that those who pay them run up health care costs lower than the "healthy" by double-digit percentages. Financially disincentivizing "unhealthy behavior" with sin taxes, despite its popularity with the arithmatically clueless, will only serve to accelerate the bankruptcy of the existing health care apparatus.
Myth #2. "Preventive health care" practices save money. Preventive health care is without question best medical practice, but in no way would it save money. The premise is that if more people receive extensive testing for conditions that may arise in the future, it will be cheaper to treat if it's detected early than if they later get sick and require more costly medical procedures. It sounds perfectly reasonable, but the only problem is that for every person testing positive for the condition they're being tested for, there are likely to be 99 others who test negative. The cost of testing 100 healthy people easily outweighs the cost of treating one sick person. Again, preventive care is wise medicine, but it's unwise from a cost-control perspective.
Myth #3. There will be no "death panels". The Republicans were politically shrewd to invoke the "death panel" language in the midst of a national health care debate because the rationing of costs will be the only way we can stop a national health care plan from going bankrupt in the course of 20 years. As disingenuous as it is to see these recently converted Medicare enthusiasts in the Republican Party stake out a position that effectively marries them to unlimited spending on every Medicare recipient who wants Cadillac end-of-life treatment, the GOP is clearly calling the Democrats' bluff here. Since the fastest-rising cost of health care is end-of-life care, it's a painful truth that the party in power when health care reform becomes reality will have to start telling seniors on Medicare "no" on expensive treatments and prescriptions designed to keep them alive another two months. It's common practice in Canada, Britain, and every other nation with national health care plans. And it would have to be common practice here or the cost curve for ObamaCare would quickly head off the same financial cliff that Medicare is now.
If I'm a senior, health care reform done right is all pain and no gain for me. While I generally respect seniors, the reality is that those over age 65 already enjoy a socialist utopia even though in an age of rising life expectancies and a swelling of their ranks, maintaining a socialist utopia for this demographic is the least financially possible. Something's gotta give, and for me it's an easy choice. With 47 million working age Americans uninsured and being denied basic medical coverage outside of catastrophic care in emergency rooms, seniors have some nerve to say their children and grandchildren should continue to be denied basic public health care coverage while their own public health care coverage should be limitless. As the Baby Boomers continue to retire in ever-rising numbers, expect a political realignment divided on generational lines fighting for limited public resources. If we think the debate is ugly now, it's gonna get far worse.
But getting back to the current health care debate, my preferred plan is of course the plan that is politically off the table....a single-payer plan with cost rations (i.e. death panels) much like every other civilized economy in the world with a far more efficient health care system than ours has. Absent that, the least terrible option that is on the table is Obama's "public option". His marketing of the public option as "paying for itself" is of course delusional. Several of the plan's critics are correct in their objections that private insurers would dump high-risk customers and thus force the sickest demographic of Americans onto the public plan, with exploding costs. Nonetheless, once established, the public option's inevitable cost-control failures would almost certainly trigger a further transition into the preferred single-payer plan I cited above. It'll be messy, and costs will go dramatically up before they go down despite Obama's irrational rhetoric to the contrary, but a generation from now we most likely would be in a position to "bend the cost curve downward".
Of course, the least terrible option of a public plan is very quickly headed off the table, and it looks like the "health reform" we will end up with is the most terrible option....a multitrillion dollar taxpayer subsidy to the existing insurance industry labyrinth that will allow their unsustainable health care cost structure to spiral even further out of control, only now using taxpayer money along with fast escalating customer premiums to do so. The best analogy to liken what this brand of "health care reform" would amount to is financial aid to private colleges. Tuition at private colleges rises at about four times the rate of inflation every year as a direct result of the majority of their students getting taxpayer-subsidized tuitions, with average tuition rates at more than $30,000 per year and with no end in sight. Similarly, if we think our health insurance premiums are high now, just wait until the insurance companies are assured to ever-rising taxpayer giveaways financing their operations.
Furthermore, I have a major ethical problem with the idea of mandating that currently uninsured Americans pay Big Insurance a premium for a "collective pool" that, given the youthful demographics of most of today's uninsured, will almost certainly be consumed by people older and wealthier than themselves. The health reform plan that passes is very likely to have this mandate, which amounts to yet another financial assault against lower-income Americans on top of the mountains of new "sin taxes" disproportionately clobbering them already.
I would almost prefer we limp along with our current broken health care system a few more years than to pass the "compromise" plan likely to be signed into law next month which would make the current system dramatically worse. If this passes, we'll have to revisit health care reform a few years from now anyway because of the explosive growth in costs that always comes when massive taxpayer subsidies to private companies allow them to operate outside the parameters of market forces. Regrettably, it'll almost certainly be too late before this country gets serious about controlling health care costs and moves past the aforementioned myths that contribute to the cost escalation. Bottom line.....somebody needs to start telling seniors "no" sometimes or the system will be brought to its knees. Nobody is willing to talk about that. But they have to.
posted by Mark at 10:36 AM
6 Comments:
We are not going to be able to "wait a few more years" to get healthcare done. You yourself say that Republicans are likely to regain Congress and if that happens, there wont even be another debate on healthcare reform for probably another 20 years. We all remember what happened after 1994.
There will be no other choice because this problem isn't going away whether we do half-assed "reform" or not. The cost curve will make inaction scarcely an option. The bill we're likely to pass this year is just the sort of crummy law the Republicans would pass if they had full control of Congress anyway, so I don't see any real upside to a Democratic supermajority. The Republican plan wins at the end of the day anyway.
Republicans would do nothing if they had control. Look at the 12 years they controlled Congress. All they wanted to do was "tort reform" which would do almost nothing for healthcare costs.
Your position is at best incoherent here. You're now saying that Democrats need to take this rare opportunity of unified government to pass health care reform through....only a few days after saying that you wish John McCain had been elected President. Huh?
In case you weren't aware, John McCain opposes health care reform.
I should have added that I wish McCain had been elected.....If/Once we dont pass healthcare reform. I am willing to lose the majority if we can get a decent healthcare reform through. I am not willing to lose the majority again just to get a Democratic President for four or maybe eight years that simply rubber stamps everything that Republicans want anyway(ie Clinton).
I agree that sin taxes are a very stupid idea, and I am aware that "unhealthy" people don't last as long as "healthy" people. I think a better substitute for this campaign is to promote healthier lifestyles (without those stupid taxes) so people can stay active longer and possibly lower the expenses they'd incur on Medicare. I think people who do take good enough care of themselves over their lifetimes can help avoid or delay Alzheimer's, osteoporosis, etc. I definitely want to stay healthy and active as long as possible while needing as little medical care as possible outside the basics.
I also agree that "preventive care" for everyone is excessive, and I am thinking such care should only be reserved for people with at least one risk factor such as family history, like somebody who has a family member with heart disease can undergo preventive care for that.
And finally, I think that end-of-life treatment should be scrapped completely. What's the point of extending life for another 2 months if the person is still going to die after those 2 months anyway? That's 2 months' worth of resources down the drain, which could have been put to many other uses.
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