U.S. Health Care Reform: Is It Possible to Gain Without Pain?

The recent media frenzy surrounding the current health care debates in Washington has driven me to take a slight detour back to health care issues (I had been focusing on a series of entries about diabetes care).  In the fall of 2008 and extending into early 2009 I wrote quite a number of entries about the problems with U.S. health care and a proposal for fixing our ills (literally and figuratively).  Through the spring of 2009 I sat on my hands and listened to the debates and I have become increasingly dismayed at what I have been hearing.  I am now not one bit optimistic that the U.S. Congress will be able to enact any meaningful health care fixes.

Where do things stand at the moment?

It’s hard to be sure exactly what is happening in Congress.  The current debate seems to have centered on whether to have a government run health insurance (I’m not sure “insurance” is the correct term) option that would compete for customers with traditional health insurance companies.  The idea would be to keep the insurers “honest.”  It is my assumption that “keeping the private health insurance companies honest” means forcing the private insurers to compete with a reasonably priced government insurance option.  There is a long editorial about this subject in today’s New York Times (Sunday, June 21, 2009) as well as an article summarizing a recent national survey on people’s views about universal health care.  These are both worth reading but neither get at what I view as the “missing link” in almost all of the discussions about health care reform, namely, just how are we going to pay for things?

In my earlier entries about the U.S. health care mess I tried to emphasize over and over that the 2 big problems were inadequate access to health care and high and ever increasing costs.  I must have sounded like a broken record when I said over and over that we cannot hope to fix either of the 2 problems unless we fix both of them at the same time.  It’s all good and well to have a government health care option that competes with private insurers but no one has spelled out how we will be able to afford it.  The fact that a government plan would have lower administrative costs than private insurance plans does not in any meaningful way explain how we will be able to pay for coverage for many millions of Americans who currently have no health coverage or inadequate coverage.  Look at Medicare, another government run health care option.  It is fast going broke.  If we cannot control health care costs, not just slow the inevitable increases over time, we are doomed to failure.  We MUST “bite the bullet” and deal with the costs.  That is not a very appealing notion since there will need to be quite a bit of pain spread around.  We will need to pay primary care givers a little more and specialists much less.  We will need to pay hospitals and medical supply vendors much less for their services.  There is no way to decrease costs without paying some people, companies, and institutions less, and I mean, far less, than what we are now all shelling out for health care (over $8000 per year per man, woman, and child in the U.S.).

Just what am I trying to say?

Unless we tackle health care costs NOW, none of the current proposals for health care reform will stand any chance of getting through Congress when the costs of providing universal coverage are presented.  Remember Massachusetts; they had a relatively easy time dramatically increasing the number of insured people when they passed a law requiring all people to have health insurance, but they didn’t work on the cost side and the plan as it stands is not economically viable.  The New York Times survery on health care I mentioned above found that a majority of people in the U.S. who currently have health coverage would be willing to pay $500 more a year if it meant all people would have health care coverage.  That’s a laugh- unless we get our arms around health care costs, $500 will be only a small fraction of what the extra costs would be to provide universal health care coverage.  Then how willing would our good citzens be to chip in?

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