Americans are being bombarded with a confusing salvo of different plans to fix the nation’s health-care system. After a decade-long dry spell, almost every politician, every large employer, every consumer and industry association and, of course, every presidential candidate, has a health-care reform idea.
Isn’t it wonderful?
Health-care analysts and economists say this is part of a predictable cycle, in which hopes are raised for a Big Fix, only to be shredded by political — and budgetary — realities.
After all, they say, if fixing health care was cheap or easy, it would have been done by now.
Granted. The complexity of the problem is enough to daunt any but the bravest policy wonks. But this isn’t some minor twinge that can be put off until much later. It’s a full-fledged pain in the budget — local, state, federal and personal — that is only going to get worse.
You’re going to hear a lot about these proposals. You’re not going to hear a lot about how much they’d cost. Here’s a hint: If a politician says he or she will pay for universal health care by cutting waste from current practices, don’t believe it. Yes, there’s lots of waste — by some estimates up to one-third of what’s spent. But the problem is figuring out which third — that is, which expensive high-tech test, which surgery, which bold new treatment will turn out to be overused and ineffective.
It’s also popular to tout the idea of preventive care as a panacea: If you don’t get sick, you don’t spend money at the doctor’s office. That’s true. But whether that saves money depends on how prevention is achieved. Convincing people to stop smoking, exercise more, and eat healthier no doubt pays dividends and needn’t cost all that much. Some employers and hospitals are even experimenting with offering free care to those with chronic conditions like diabetes that, if left unchecked, could lead to extensive and expensive hospital stays. But prevention easily can veer into mass screenings of the healthy to find the few who aren’t. That’s a waste of money.
Finally, there’s the blame game. Some may seek to blame patient-gouging doctors for soaring costs. Or hospitals and their egregious, phone book-sized bills and exorbitantly expensive aspirins. Or denial-crazy insurance companies. Or drug companies that reap huge profits.
All of those bear responsibility for rising costs. But these complaints are exaggerated. One economist estimated, for instance, that if all drugmaker profits were rebated to patients, health spending would drop only 1.2 percent.
What’s driving most health-care spending is simple: It’s us. Americans are aging — Baby Boomers are moving into retirement — and that means a surge of people seeking more and costlier medical care. American medicine delivers wondrous new high-tech screenings and treatments, miracle drugs and innovative therapies that improve and extend lives. But it’s not cheap.
So as the candidates roll out their plans, here’s what we’ll be listening for:
*A plan to cover more Americans with health insurance. Too many people end up in emergency rooms, racking up billions in medical bills that they can’t pay. What happens? The costs get passed on to the hospitals and eventually to paying customers and taxpayers. If you can’t afford coverage, the government should help you buy it. For those who can afford it and just don’t want to spend the money, the free ride’s over. That’s the underlying premise of Massachusetts’ innovative plan. That basic principle should be part of any national overhaul.
The tricky part here is where to draw the lines. Who gets the subsidies, who pays up? How comprehensive should the insurance be? Massachusetts’ pioneering effort is set to begin in July. But it has already fallen short. Recently the state exempted nearly 20 percent of the uninsured adults from the state’s new requirement to have health insurance. The state allowed that exemption because even the lowest-priced insurance in the state’s scheme would not be affordable to those with low and moderate incomes who did not qualify for subsidies. But some of these folks might have been able to buy insurance, had the state not insisted on comprehensive coverage, including prescription drugs. Our view: Even a low-cost catastrophic policy is better than nothing.
*A reasonable plan to start easing away from employer-based insurance. That’s the philosophy of Sen. Ron Wyden’s (D-Ore.) ambitious plan. But this is a dramatic change that won’t, can’t and shouldn’t happen quickly.
Any proposal should allow people to buy insurance at competitive rates from private carriers — and guarantee coverage, the way an employer does now — without creating another huge federal bureaucracy. Insurance should be portable so that people wouldn’t fear losing coverage if they lose a job or simply want to change employers. Similarly, insurance companies should be able to sell across state lines without meeting different coverage mandates for different states. That could help drive down costs and make insurance more accessible.
A modest first step on this road: President Bush’s proposal to create a standard federal tax deduction for health insurance, to equalize the tax breaks for those who buy insurance through an employer and those who don’t.
*The wisdom not to repeat failure. Forget about a single-payer system in which the federal government runs health care in America. There’s a reason the Clinton approach flopped. Americans like choice — of doctors and care regimens. A single federal entity setting prices and paying most every American’s health bills is a nightmare bureaucracy that is destined to shortchange patients and choke the innovation out of American medicine. In other words, one size for health care in America does not fit all.
When Medicare officials peer into the future, they see a hemorrhage of red ink in the coming decades. Those numbers suggest agonizingly hard choices are coming. No one wants to suggest that there are limits, that we can perform miracles for some, but can’t afford to perform them for everyone, regardless of age or physical infirmity. Is prolonging the life of a 90-year-old by four months more important than educating a preschooler? And who decides?
That debate hasn’t even started in earnest.
Americans and their political leaders need to acknowledge a basic truth: All the cutting-edge treatments and miracle drugs and innovative surgeries come with a price: rising health-care costs. Despite what some politicians may promise, there’s no painless cure.
