Friday, December 11, 2009

Health Care Reform Turning into Debacle

Back when Mr. O introduced his health care reform proposals, a commonly-heard tidbit went something like "anything that passes will be better than doing nothing". Indeed, that rationale boosted support among many in congress.

However, the gist of current versions being debated in the senate increases the appeal of doing nothing. Big Pharma and Big Insurance have spent millions to craft legislation they are happy with, and their happiness is a worrisome sign. The system that results could be more costly and complex than ever.

The fundamental problem is simple enough, and should lend itself to simple solutions. Since everyone potentially needs health care, a universal system of spreading costs makes sense. The current distortions in health care funding, along with the numbers of uninsured are the driving force behind reform efforts. Still, it's hard to see how the present legislation will bring about any improvement. We may end up with insurance companies barred from excluding pre-existing conditions or charging more for them, but at a cost that threatens to push even further out of reach of the average citizen.

Obama has pushed hard for "cost containment", but which players are going to line up for the haircut? Not big Pharma. Not Big Blue and the other insurers - they have lined the pockets of enough senators and congressmen to see to that. So the soft targets for cuts are Medicare and Medicaid, and just how will that be accomplished? Doctors and hospitals get the haircut, just as they are struggling with increasing amounts of uninsured care. Not much sense in that; "cost containment" is just a PR slogan to sell the delusion that expanded care can be achieved at no extra cost.

Republicans have helped stir passionate opposition to "socialized medicine" by invoking rhetoric such as "rationing", "government takeover" and "death panels" to "pull the plug on Grandma". For those currently well-covered, this may have its appeal, but who would really stand to lose if the present insurance system were replaced by a single-payer entity? If you guessed "insurance companies", then you understand why they spent so much to manipulate the ongoing debate.

Why do we keep hearing that polls show support for a "public option", yet the chances of it passing dwindle with each passing day? The answer is obvious; big money talks much louder than individual voters.

Then we hear of nonsense such as annual and lifetime benefit caps reappearing in amendments with titles like "ending benefit caps". This is exactly the type of legislation that would be worse than doing nothing - a thousand page monstrosity that passes without anyone knowing for sure what the contents are (except for the lobbyists that crafted the details). If it ends up mandating expensive coverage that few can afford, the system will be further destabilized.

The simple solution? Why not simply expand the present Medicare/Medicaid system and fund it with the existing payroll tax. The tax rate could slide progressively according to income, with middle class workers and their employers paying no more than the amount now spent on insurance. This solution would require no increase in bureaucracy and still maintain the potential for "cost containment". With near-universal participation, costs would be spread among the largest possible base. Unfortunately, it would mean the end of the line for insurance companies, and that's why you won't see anything like this proposed.

And why is "rationing" such a bad idea? There is a cost-effectiveness curve that means most improvement in public health comes from the bottom 50% of expenditures, with further improvements diminishing as expenditures increase. With an open-ended approach to new therapies and technologies, costs can ultimately approach infinity. Some therapies provide questionable benefit or even prolong suffering. Should we bankrupt ourselves to extend the average life a few extra months? With the proper balance, we could be healthier and spend less.

This discussion inevitably leads to the choice between allopathic and integrative medicine. If alternative therapies could compete on cost-effectiveness with the accepted mainstream on a level playing field, everyone would win (except for those invested in the present high-cost system). Don't look for reform legislation to favor integrative medicine, since the big money will be lined up against it.

Perhaps our best hope is to wait for the present system to collapse completely, while adopting healthier lifestyles and learning what we can do to enhance our own health.

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