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Do the Wrong Thing

Laszewski As the Democrats make their final push to pass their health care bill many of them, and most notably the President, are arguing that it should be passed because it is the “right thing to do whatever the polls say.”

Their argument is powerful: We will never get the perfect bill. If this fails who knows how long it will be before we have another big proposal up for a vote. There are millions of uninsured unable to get coverage because of preexisting conditions or the inability to pay the big premiums and this bill would help them.

Any big health care bill will be full of compromises—political or otherwise. But this bill doesn’t even come close to deserving to be called “health care reform.”But as an unavoidable moral imperative, enacting this bill would fall way short:

1. It is unsustainable. Promises are being made that cannot be kept. As the President has said many times, we need fundamental health care system reform or the promises we have already made—the Medicare and Medicaid entitlements, for example—will bankrupt us. What few cost containment elements the Democrats seriously considered are now either gone from their final bill or hopelessly watered down—most notably the “Cadillac” tax on high cost benefits and the Medicare cost containment commission.

2. It is paying off the people already profiting the most from the status quo. Many of the big special interests, that will have to change their ways if we are really going to improve the system, are simply being paid off for their support. The drug deal, the hospital deal, promises not to cut or change the way physicians are paid, all add up to more guaranteeing the status quo rather than doing anything that will bring about the systemic change everyone knows is needed.

3. Nothing in these bills will fundamentally change our current fiscal course. As the CBO, and every other expert has said, if this bill becomes law we will continue on the same cost trajectory we are already on. Yes, the CBO says the Democratic plan will reduce costs during the next ten years by about $100 billion—but that only means they would be $100 billion less than the $35 trillion they would have been anyway! That is merely a rounding error on the track we are already on.

4. There is nothing here that will stop unaffordable health insurance rate increases. Lately supporters have said this bill is the solution to the recent big individual health insurance rate increases we have been reading about in the press. But there is little in this bill that will mitigate or control any such increases because so little would be done to impact underlying health care costs.

We often hear the argument, “Let’s get this entitlement expansion bill passed and it will force us to deal with costs later.” If we don’t now have the political courage to face daunting health care costs in the face of exploding deficits how will we have that courage later? I will suggest that adding 30 million more people to an unsustainable system expecting it will create an even bigger crisis and thereby force real reform is tantamount to reboarding the Titanic in the hopes it will sink faster. It is also hard to see how doing such a thing is the politically courageous thing to do. Just where is the moral imperative in ramming a trillion dollar entitlement expansion through knowing full well it will make our long-term deficit nightmare even worse—for those now uninsured and for everyone else? The Democratic health care bill makes little if any systemic changes to the health care system—certainly not at the level we need. The Democratic health care bill makes promises we cannot keep. Proponents of the Democratic health care bill make the claim that it will make health insurance affordable, improve our deficit outlook, and make our health insurance system sustainable. None of those claims are even close to being true and everyone who knows anything about this debate knows that. Heck of a foundation for doing the “right thing.”

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog, where this post first appeared.

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MYMILLIONSITEmichaelHand Gjdrbar Recent comment authors
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MYMILLIONSITE
Guest

THIS IS A PETITION TO THE UNITED STATED FEDERAL GOVERNMENT FOR A INDIVIDUAL OPT OUT REQUEST FOR HEALTH CARE We The Undersigned Wish To Convey By Their Signatures Below That They Wish To Have The Same Rights Under The Current Health Care Legislation. That Allows The Individual States That If This Would Place An Economic Burden On That State They Have The Option To Opt Out Of This Mandate. Currently Over 35 Of The 50 States Have Or Will File A Legal Action Against Washington To Claim This Is An Unconstitutional Bill. If The States Are At 38 against and… Read more »

michael
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michael

nonprofit health care insurance,when you take away the capitalist greed,and realize that one humans life no less/more important than the others. success is inevitable.besides the last time i checked china was footing the bill.health care is not what got us into this economic mess.war=major debt!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

michael
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michael

non profit insurance companies. if you take away the capitalist greed from the health care system,and realize that one humans life is no less/more important any one person regardless of who’s paying the tab.the last time i checked,china was paying the tab.

Nate
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Nate

surprise Peter missed about 90% of it. rbar, few basic concepts fitted to each clients particular need, this theory being one of them, not all groups or individuals are the same and thus we shouldn’t try to force our menu of products on them. We identify our clients needs/wants then figure out the most cost effective way to deliver them. It cost money to insure risk, thus we advise clients not to insure non risk. Office visits, dental, and other such claims are not risky, I can usually tell pretty close how much they will cost you in a year.… Read more »

Peter
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Peter

rbar, Nate’s biggest contribution to lowering costs is the purchase of a high deductible health plan. He then does some micromanagment of some doc and drug spending and attempts to use public programs for some other savings. I’m not sure how happy the employees are under his managment, but the fact that he says companies only come to him at a time of crisis shows they have to give up a lot.

Hand G
Guest

From an outsiders point of view – and as a Brit well aware of the shortcomings of government and government run healthcare – I think the health care debate in the US has highlighted far more than health care insurance being close to meltdown; not forgetting the recent Wall St meltdown… the element that links both is that Wall St and the insurance companies effectively own the US government.
US democracy is dead; the lobbying billions have killed it.
God Bless America and I hope one day it becomes a democracy once more.

jd
Guest
jd

Margalit has it right. Nearly everyone who opposes this bill is making the mistake of comparing it to politically impossible alternatives. I’ve been saying since 2007 here that universal coverage is the easy part (!) while deep cost controls are far harder because with these you cut into the revenues of very powerful lobbies that have public support (i.e., not insurers). Bob has shown me nothing to indicate that he knows how to get reforms passed which freeze or lower provider costs. We can all point to reforms that would lower them if passed. In effect he is opposing real… Read more »

rbar
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rbar

Nate, how exactly do you do all that (“This is despite the fact we have a 25 year track record of working, don’t change benefits, and drastically reduce cost.”)? Maybe I missed that in one of your past posts, but I cannot read all of them as I have a daytime job …
Extraordinary claims require extraordinary evidence.

Nate
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Nate

great idea maybe following or maybe not… “They see the bill providing virtually no meaningful reforms that will translate to relief, so they’re hunkering down and looking more closely at products and programs that can hold down their costs without sacrificing quality.” This is a very important perspective that no one wants to dicuss. Most of these products and programs have been around for a while, yet they had very little adaption. The press and proreform lobby want to scream about how out of control cost are but the fact is it is not. If cost was as bad as… Read more »

Margalit Gur-Arie
Guest

Brian, Many blog pages ago, when I had my personal meltdown because this bill is a shadow of it should be and this President is not the radical agent of change that I hoped he would be, I learned something from reading and writing on this blog. I learned that what is right is almost always tempered by, so called, political realities. The political reality today is that there is zero chance for true health care reform to occur in one big push. It is impossible for the true reformers to go “huddling away from the lobbyists”, and even if… Read more »

spike
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spike

Brian,
Unprofessional it may be, but you didn’t convince me I was wrong.
You wrote a very long post that manages to miss the key points. You believe this bill is worse than the status quo and you believe a better bill is politically possible.
If that is the case, perhaps you should be running for office, your talents are being wasted.

Brian Klepper
Guest

Spike, Matthew also publishes Nate, but I’m not sure that’s a great idea either. I can think of ways to disagree with Bob, but suggesting that he doesn’t know what he’s talking about is both unprofessional – this assumes that you are a health care professional – and inappropriate. Many people who make business and policy decisions listen very carefully to what Bob has to say. Now to the point. Remember the Republican Medicare D heist? Orchestrated by the US Chamber and the Employers’ Coalition on Medicare, the Republicans created an enormous windfall for 1) Fortune firms (through subsidies) and… Read more »

Dennis
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Dennis

spike, Agreed. It is the ongoing problem with EVERY opponent of the health reform legislation moving through congress (except for Kucinich, who is now on board).
They’re against the bill, but cannot tell us what they specifically support and how that would specifically benefit anyone.
The best we get from their mouths is the mantra that “the free market works best.” Unfortunately, with the case of private health insurance, that’s been proven untrue by the American experience.

Dino W Ramzi
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Dino W Ramzi

It is unfortunate that there is not as significant an effort outlining the economic advantages of health care as their has been looking at the costs. One of the messages being lost here is that reducing health care costs makes the US more competitive globally. It is difficult to factor that into a CBO projection. It is also difficult to identify those aspects of health care that actually can and do reduce overall costs by virtue of their cost-effectiveness, but they are few and subject to controversy (cf: vaccines). We must be satisfied with the imperfect and not make the… Read more »

spike
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spike

Bob, I asked you this on your blog, of course you don’t publish my comments, but Matthew does! Are you saying the status quo is better than this bill? Are you saying that if this bill fails a better one is right around the corner? What exactly is your point in all of this? From past posts, it sounds like your point is that Democrats should scrap this bill and do something even more incremental than this, like limit reform to malpractice reform. Wouldn’t doing something so small make every problem in your list even worse than it would be… Read more »