Tackle health costs first, expand coverage later?
Obama is increasingly hearing that he should cut health care reform into two parts. Let's get fiscal conservatives on board by dealing with out-of-control medical costs now, the advice goes. Worry about expanding coverage to the uninsured later. I think this is a losing tactic, as I'll explain below.
David Ignatius laid out the case in the Washington Post on Saturday.
If liberals really want to show they are serious, they should begin with our existing single-payer behemoths, Medicare and Medicaid... the White House should mandate that, within three years, these programs will shift from the current fee-for-service approach to a system that pays for value -- that is, for delivering low-cost, high-quality care.
Joe Lieberman picked up the theme on CNN yesterday.
I think great changes in our country often have come in steps. The civil rights movement occurred -- changes occurred in steps. Let’s focus now on how to reduce costs. That’s been a central theme of the president.
Problem: The idea of reducing costs -- and that idea alone -- is responsible for huge amounts of the resistance to the Democrats' plan at the town hall meetings and elsewhere. The outcry isn't just from those who object to government expansion and don't think we can afford extending coverage. It's from folks -- mainly seniors -- who have already been let into the government-paid health-care club and are worried that reform will limit the virtual carte blanche they now get under Medicare.
Ross Douthat wrote about this in the NYT last week.
If the Democratic Party’s attempt at health care reform perishes, senior citizens will have done it in, not talk-radio listeners and Glenn Beck acolytes. It’s the skepticism of over-65 Americans that’s dragging support for reform southward. And it’s their opposition to cost-cutting that makes finding the money to pay for it so difficult.
I've heard from these folks myself. The nutty "death panel" talk resonates with them. Many of them talk a good game about the dangers of big government. But at heart what they're worried about is that more health care for the uninsured or cost-control in any form will mean less health care for them. Plain and simple. That sort of "I want mine" sense of entitlement is, as conservatives know, one of the most powerful forces in politics.
Obama doesn't want half a loaf. He wants health cost control AND health coverage expansion. But I'm skeptical that tackling the first part by itself will be any easier politically than going for the whole thing.
Comments
Exactly the point if you don't find a way to control costs, putting fifty million more people into a flawed system will make matters worse. Look at Medicare that is a public system, has it controlled costs or even made care affordable? Look at the out of pocket costs or the cost of supplemental coverage relative to 65+ incomes.
My views based on 47 years experience in health benefits are on my blog at
http://www.quinnscommentary.com
Posted by: R Quinn | August 24, 2009 11:14 AM
What a shock! Medical costs are higher for our oldest and sickest than they are for the rest of us. Funny, I'm young and healthy, and between insurance, copays and out of network doctors, my care costs over $11,000 per year.
Medicare for all please!
Posted by: Scottilla | August 24, 2009 2:25 PM
Thinking Americans know that we are BROKE and that we must not allow Obama to continue STEALING from our children and grandchildren to implement despicable scams like Obamacare and cap and trade.
Obamacare has nothing to do with improving or expanding health care. It's just another power grab that will further destroy our health care, destroy our economy, steal money from our children and grandchildren, multiply our deficit, and enslave us through lies, manipulation, intimidation and coercion.
No wonder the Russians are gloating: “The final collapse has come with the election of Barack Obama. His speed in the past three months has been truly impressive. His spending and money printing has been a record setting, not just in America's short history but in the world. If this keeps up for more than another year, and there is no sign that it will not, America at best will resemble the Wiemar Republic and at worst Zimbabwe. http://english.pravda.ru/opinion/columnists/107459-american_capitalism-0
Fortunately, as we can see in the town halls, most Americans have NOT been dumbed down and they will do whatever necessary to defend themselves, their children and grandchildren from Obamacare and Marxism.
Posted by: AntonioSosa | August 24, 2009 2:36 PM
David Ignatius's statement calling for Medicaid and Medicare to shift away from Fee-for-Service to a 'value added' reimbursement structure in order to cut costs while cute and clever reflects profound ignorance of the subject matter.
First, the Medicaid Program is setup as a Block Grant Program to the states. It is those states that determine exactly how the money is spent. Since we are talking about Healthcare Reform instituted by the Federal Government that is where I will focus.
Medicare is a federal program that indeeds acts much like a Single Payer System. It does not use a Fee-for-Service reimbursement model. Under a Fee-for-Service scheme the provider determines the rate schedule for services provided. In this model Individual Insurance Companies choose which providers will be included in their network providers. That is why this system evolves into a Multipayer System.
Medicare while not a Single Payer System in the strictest sense of the word does have most of the characteristics of a Single Payer System. Chief among those characteristics is the ability to set it's reimbursement schedule. It is this mechanism which controls cost.
But there is an overarching point that both Lieberman and Ignatius do not understand. Most of the waste in the US Healthcare System is in the Financing of Healthcare. The Healthcare System in the US can be broken up into two segments. The Financing Arm and the Delivery System. According to PNHP (Physcians for a National Health Program) the Financing system wastes 400 Billion Dollars annually while the delivery system waste 12 Billion Dollars annually. While no one appreciates lost money recovering the lost money in the Delivery System if 100 percent successful would not even begin to fulfill the needs of the 46 million uninsured in this country. On the otherhand if most of the money lost in the Financing System were recovered this country could provide healthcare coverage for all of the uninsured.
What Lieberman and Hancock fail to grasp is runaway healthcare spending comes part and parcel with a financing system that forces hospitals and healthcare providers to fight for their budgets asprin by bandaid with insurers. This creates Megabureaucracies at both ends of the system. The way one reduces costs is to eliminate those bureaucracies through implementation of a Single Payer System. Such a System would provide for monthly global budgets to hospitals and other providers.
That is how you cut cost Mister Hancock. And you do it simultaneously with providing coverage.
Bob Marston
SinglePayerNow
http://singlepayernow.net
Posted by: Bob Marston | August 24, 2009 2:53 PM
In my experience "most of the waste" is from defensive medicine and blatant lack of responsibility for one's own health. Address malpractice reform and and make people accountable for their behavior and we'll be able to afford insurance for all. Why children should go without insurance while an obese smoker gets whatever his docs thing he needs to avoid getting sued, is beyond me. Ask any internist/FP/PCP. We know where the money is going. Regardless of what the PNHP says (not the most objective of sources, and there are plenty of others that estimate the waste from defensive medicine to be hundreds of billions).
I agree with Obama that we need EMR that are unified so we can avoid repeating stress tests, caths, echos, etc. just because a patient goes to a different hospital. But that is secondary to the above issues.
WHEN is anyone going to listen to those people in the trenches--in the frontline of health care delivery?? And unfortunately, the AMA does not count.
Posted by: anon | August 24, 2009 6:19 PM
There are several things that need to happen to reign in health care costs. First, we need to have a universal accessible medical record so that we have immediate access to ALL the patients' healthcare info at our fingertips. Our current system of paper charts and even the myriad of EMR'S that don't communicate with each other has a huge cost in waste and inefficiency.
Second, patients need to be more responsible for their health. Obesity is rampant in our country and it is getting worse. Patients who choose to continue unhealthy habits and behaviors should be free to do so, but should pay a higher insurance premium and higher percentage of their health care costs. This will motivate people to live healthier if they must pay more for their healthcare if they smoke or if their BMI is higher.
Finally, health care consumers must have more control over how their health care dollars are spent. This will bring competition for medical services back and will drive costs down. There should be a sliding scale cost out of the pockets of the patients at the time of service for services provided. This can be on a sliding scale based on income, health habits, and medical necessity. The most cost effective health services would be nearly free while the least would cost the patient more. Once patients' pocketbooks are driving the system, they will choose the most efficient providers and the providers will compete for their business, thus lowering costs.
A single payer system without some sort of patient responsibility will bankrupt the country and will fail to provide efficient, cost effective health care.
Posted by: UROLOGIST IN PORTLAND | August 25, 2009 5:10 PM