Archive for December 27th, 2009

The nebulous nuts and bolts of health care reform

| December 27, 2009 | 3 Replies
The nebulous nuts and bolts of health care reform

How is that “health care reform coming? New York City’s Mayor Michael Bloomberg, a savvy businessman with a long and successful career, is skeptical regarding the pending health care reform bills. This is what he had to say on Meet the Press today:

MAYOR BLOOMBERG: You know, if you really want to object to something in this bill, number one, I have asked congressperson after congressperson, not one can explain to me what’s in the bill, even in the House version. Certainly not in the other version. And so for them to vote on a bill that they don’t understand whatsoever, really, you got to question how–what kind of government we have. Number two, when they talk about bending the curve, as, as the governor said, bending the curve is a flimflam euphemism for increasing costs, but we’re going to say we’ll do it at slightly lower rate than we would have otherwise.

GOV. PATRICK: That’s not what I’m talking about.

MAYOR BLOOMBERG: I understand that. But they are not talking about reducing costs, they’re talking about chancing the first derivative.

MR. GREGORY: Slowing it, right.

MAYOR BLOOMBERG: Slowing the growth down. And when you look at where the cost savings are going to be, well, they’re going to cut something out of Medicare and Medicaid. Now, anybody that runs for office will tell you, you don’t do that.

MR. GREGORY: Right.

MAYOR BLOOMBERG: I mean, the bottom line is it’s so politically explosive, it really would be a first time in the history of the world if they ever cut anything out of either of those two programs.

I suspect that based upon the utter inability of any credible knowledgeable person to frankly state the cost of “health care reform,” that Americans are in for a rude awakening. Consider the starting point: the terrible financial condition of Medicare. Here’s how bad it is:

The present value of unfunded obligations under all parts of Medicare during FY 2007 over a 75-year forecast horizon is approximately $34.0 trillion. In other words, this amount would have to be set aside today such that the principal and interest would cover the shortfall over the next 75 years.

No private non–criminal corporation would submit operating budget this insane. Yet this is the type of program that we have come to expect from Congress, and it is based upon scores of accounting tricks. These sorts of tricks and traps are exactly what has been alleged about the current proposals for “health care reform.” Consider the arguments articulated in the November 13, 2009 issue of Reason.

Congress is using “every budget gimmick in the book” to conceal hundreds of billions in healthcare-reform costs that will lead to “massive tax increases” and higher insurance premiums, one of the country’s leading healthcare experts warns.

Early on, Obama originally pledged that his plan would save the typical American family $2,500 a year in healthcare costs. The main purpose of health care reform was “cost control.” (see Obama’s State of the Union Address from February 2009). Where is this cost control in the current bills? How can we possibly cover tens of millions of people who can’t otherwise afford coverage, yet save lots of money for those who are paying their way?

Both of the current proposals both depend on a government-funded free-market program administered by for-profit insurance companies. Paul Krugman has argued, however, that the free market doesn’t work regarding health care.

[Y]ou don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket. This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping.. . .

We are a country filled with people who abuse their bodies and then depend upon the health care system’s expensive treatment. The annual cost of obesity alone in the U.S. is $200 Billion. In fact, we spend less than one percent of total health care spending on prevention. Where is the “stick” (or the “carrot”) in the current proposals that will actually make obese, chain-smoking and otherwise reckless Americans change their wasteful and destructive ways?

These are my concerns about the current proposals. Well, those concerns and these and these and these . And now we have the business-savvy mayor of NY stating that he has yet to find a member of Congress who understands how the current proposals would really work. And we have a Congress with a history of not actually dealing with fiscal catastrophe, but only putting it off for a few years. We have a system that has yet to explain how it will force Americans to live healthier life styles, in order to save that money. We have competing 2,000 page proposals loaded with lots of stuff that will only be revealed AFTER “reform” is passed. I can already hear it: “We didn’t catch that obscure language inserted by [financially interested corporation] that will cost taxpayers an additional $40 Billion every year”).

What sustains the momentum is that we will purportedly be insuring thirty million more people, even though it is not clear what we will be giving up in order to do that. Things that motivate the idea of “health care reform” are some low-hanging fruit such portability and restrictions on denying coverage for pre-existing conditions. I’ve advocated that we should pass laws regarding these obviously needed measures separately, so that we can then really look carefully at the rest of the proposal separately, to just it on its own merits, if we can cut through the morass of accounting gymnastics that apparently serve as the backbone of most of the package. Another thing that motivates passing “health care reform” is the name of the legislation itself. Who could possibly be against “health care reform.” A good title does wonders for ramming through indecipherable legislation.

This is the current health care “reform,” as best I can discern it. It’s not looking promising, because it’s not looking financially sustainable.

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