Today’s news is that there is now a double header running health care with the addition of the
(notably all-female) team of Sebelius & DeParle joining Orzsag, Zeke Emmanuel and a host of others with influence on the health care policy tiller. We await a CMS leader, and probably multiple other appointments quickly down through the ranks.
However, I remain convinced that not much is going to happen, and that even if Obama’s “plan” gets enacted, it’s a limited reform that is not the big bang we need to do the job.
Thankfully rather than me having to explain why, Bob Laszewski (who makes me feel like an inadequate noobie every time I read his stuff) details the problems over at Health Affairs blog. The Bob L summary?
- Obama’s team has not aggressively gone after the hard cost problems as part of Medicare & Medicaid, preferring to trifle around the edges with modest cuts
- For the (these days relatively modest!) $120 billion a year the reforms are going to cost it’s only looking to the health care system to pony up around half of it—the rest (c. $65bn a year) will come from the taxpayer.
- The details of the plan are being left to the Congress which means that it’ll be watered down.
As I said in the looooong comment thread on Maggie Mahar’s piece on THCB yesterday—BTW Maggie’s comment on her own piece may be the longest comment I have ever seen on any blog!—there’s no reason that the rest of the economy should contribute more to the health care system. As John McCain might say (albeit with disapproval), we need to redistribute the wealth within the system.
Furthermore, despite Orzsag’s understanding of the long-term impact of health care cost increases, there doesn’t seem to be any indication of how the overall cost increases within the system is going to be ratcheted down. Zeke Emmanuel (echoing Vic Fuchs) has an answer in his excellent book—tie health care costs directly to a visible VAT tax that can only be increased by a Congressional vote. But the Obama team thus far says, we understand the problem, but we want to punt the reform process to Congress. They’re not even apparently insisting on a public plan as part of their package, or at least it’s not in the eight principles.
Now I understand that they don’t want to repeat the Clinton mistakes of taking too long and over-detailing the approach. And I would be OK if they took the LBJ approach and basically bought off all the interest groups and spent that extra money, if we achieved the real issue behind health reform—getting everyone covered in a single social insurance pool. Because if we did that first thing, we could fix everything else later.
But instead we’re going to get some mealy-mouthed version of pay or play which, if it survives the small business lobby (and I doubt it will) will only get us about half way to solving the uninsured issue, and will leave in place the terrible mish-mash of employer-based insurance, private insurers with mixed incentives, competing incoherent benefit packages, and Medicaid as a default and screwed up stop-gap.
And the result of that will be a still large group of uninsured and no real single source for cost-containment. Which (as I’ve said a gazillion times before) means that the system will still be able to increase costs, more people will become uninsured and/or fall into the Medicaid revolving door, and the socio-demographics of being uninsured will shift upwards.
But because we will already have “done” health reform, we won’t have the political will to do it properly when the chickens keep coming home to roost in a few years.
And eventually, we’ll have to go to Medicare for all with de-facto price setting and limited global budgets, and it won’t be pretty. Nor will it be the best solution we could have.
CODA: You want to see opposition to Obama starting already? Former government welfare Queen Rick Scott—yes he of the Columbia/HCA business model of defrauding Medicare and hoping no one notices—has laughably launched a group called Conservatives
against health care for poor people Patients Rights , and worse, is starring in his own ads! I guess at least you can’t call it a Great Right Wing Conspiracy when it’s only one guy!
Categories: Matthew Holt