Skepticism on Health Care Reform 2

In the great movie Patton there is a scene where the General arrives to take command of American forces in North Africa. He wakes up a GI and asks him what he is doing. "I am trying to take a nap Sir," the soldier replies. "You get back down there," Patton says, "you're the only one in this Goddamn army who knows what he's trying to do."

So far, in the current rush to reform the American health care system, I haven't noticed anyone as clear headed as that solider. Consider this, from Jeffrey Young at The Hill:

Congressional Democrats and the White House are scrambling to regain their footing after a series of setbacks has stalled political momentum to reform the nation's healthcare system.

A cost estimate hanging a $1 trillion price tag on an incomplete bill, salvos from powerful interest groups and great uncertainty among key Democrats on what will actually be in the legislation that moves through Congress have emboldened Republican critics.

Okay. So this bill is going to cost another trillion. Is that figured into the one or two trillion a year deficits that the Administration is planning on running? I am guessing not. And how does this square with the Administrations current argument that the purpose of health care reform is to rein in costs? Can we really cut costs by spending another trillion dollars that we don't have?

But the more disturbing thing is that "great uncertainty among key Democrats on what will actually be in the legislation." If the Democrats don't know what is going to be in this bill, how can they work on the legislation? Does Obama know what he is trying to do? But it gets better.

The cost of reform and how to pay for it dominated the discussion Tuesday as Democrats were forced to respond to an unfavorable Congressional Budget Office (CBO) analysis of one incomplete part of an incomplete bill.

The CBO looked at one portion of a draft bill written by the Senate HELP Committee and found, among other things, that it would cost more than $1 trillion while providing a net decrease in the number of uninsured people of 16 million.

The CBO also threw cold water on a promise by a coalition of healthcare industry groups to reduce healthcare spending by $2 trillion over 10 years. Obama announced their promise to much fanfare, but the CBO found that while a few of the cost-cutting measures would save money, others would cost money. In sum, they would not have a big impact on federal spending, the CBO concluded.

Now let me get this straight. One "incomplete part of an incomplete bill" is going to cost us a trillion dollars. That's $1,000,000,000,000. For that much dough we are going to insure another 16 million people. That's not even half of the 40 million uninsured folks. Meanwhile, the "savings" of two trillion dollars (that would cover this year's deficit) aren't really savings at all. Some of the proposed measures would cost more money. I suppose I should be comforted that the savings part is "revenue neutral" rather than revenue depleting.

Are we trying to extend more benefits to more people, or are we trying to control health care costs? The President would surely say we need to do both. But is there any indication that anyone knows how to do that? If there is anyone in this Goddamn army who knows what he is trying to do, no one has woke him up yet.

Comments

[Erik]

KB:
I think that we should be focusing on getting everyone health care in "this army"
Health care is a fundamental right.
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[KB]

Erik:

I am very wary of fundamental rights to resources produced by others. What does that right entail? Penicillin? A million dollars worth of medical treatment that extends life for a few days? If you mean basic care, there is little evidence that anyone isn't getting that right now. So what is the trillion dollars buying?

[George Mason]

"Life. Liberty and Health Care." Don't seem to remember that one. The "health
care is a right" mantra has become another liberal idee fixe as well as a
mindless chant. What is always overlooked is 1] no one in this country is
denied health care. 2] the one issue the democrats will never address is the
price extracted by the American legal profession. If liberals were really interested in doing something about the cost of medical care, tort reform
(read: limited damages, loser pays) would be front and center in their agenda. Instead their agenda is to accrue ever more power to the government which
threatens our life, liberty, and pursuit of happiness, which are fundamental
rights

[A.I.]

You're right George, no one is denied care. But if they don't have insurance or are under-insured, they can be bankrupted by relatively simple procedures. Or their bills are paid by the county, or the medical community passes the loss to those who are insured. Even when people have good insurance provided through their employer, we all pay when purchasing goods and services. So no matter how you cut it, we are all paying.

At the same time, we are paying more for care than many other countries while getting poorer results. Time for a change?

[Erik]

KB:
There is a lot of evidence that people are being bankrupted due to health care costs. Just look it up.
By the way, I enjoy your military analogies, what unit did you serve in?
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[Erik]

Mr. Mason,
Doesn't "happiness" entail avoiding bankruptcy?
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[Miranda]

No, A.I. It's not the same no matter how you cut it.

People in general are more willing to undergo unnecessary medical treatments when they aren't responsible for paying their own bill. So the taxpayers end up paying for medical care that no one would have had to pay for if people took responsibility for themselves.

What now costs trillions of dollars could probably be much less.
Also, as George Mason points out, much of the expense is cut out of health care
when legal fees are eliminated. As the government regulates more, legal expenses become higher - especially for insurance companies.

Maybe it's true that no matter what, we all pay. But do we pay the same amount?

[Erik]

Miranda, et. al,
I think that national health insurance and tort reform go together. Unfortunately, in this country we have a tradition of legislating by law suit.
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[KB]

Erik: they serve also who only stand and wait. Or sit and watch the movie. I am very thankful that I was born in the right half of the last century.

A.I., yes we all pay one way or another. But if everyone is in fact getting basic health care, and the problem is that some people can't pay for it and are being impoverished, then the solution is to shift more money from some to others. That means that for most of us the healthcare bill will go up. Maybe that's the right thing, but is Obama telling us that? No. He is telling us we are all going to save money.

Erik: tort reform is obviously a good idea, but Obama won't really push for it because the lawyers are a vital part of his coalition. Trust me on this one.

[A.I.]

There are those who cite tort reform as a Republican canard designed to reduce the income of trial lawyers as a means to cut their contributions to the opposing party. Whether or not that is true, there is evidence tort reform would do little to reduce health care costs.

Malpractice insurance premiums and awards in malpractice cases combined account for less than 2% of health care costs. Obviously some of the cases are legitimate and malpractice insurance will still be needed even if further tort reform is enacted, so not much could be saved.

I say further reform because many states already have instituted some form of tort reform. Studies show that while malpractice insurance rates are sometimes reduced as a result, those savings are not passed along to patients. Nor is the frequency of "unnecessary" tests significantly reduced--those being the CYA tests doctors supposedly order to stave off lawsuits.

So maybe a better place to look for savings is the health insurance industry. Tell me how this layer of paper-work perpetuating, profit producing (at our expense) private bureaucrats does one thing to improve health care when they in fact are looking for ways to cut their costs by reducing care and giving the boot to anyone with chronic health problems.

As for people over-using the system, while there are a few hypochondriacs out there, I don't think most folks really relish the idea of subjecting themselves to examinations and procedures that are often embarrassing, uncomfortable or both. The vast majority of us use the health care system to treat existing problems or to prevent future problems and unfortunately, far too few of us do the latter.