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December 04, 2006
Harder, Better, Faster, Stronger
Good column by Daniel Gross making the point that, contrary to popular belief, America does have a sort of national health care system. It's just not organized in a way that makes any sense. If you tally up the amount spent on deductibility for employer-based care ($208 billion), Medicare ($378 billion), Medicaid ($180 billion), not to mention military health care, coverage for public employees, and various sundry other programs and subsidies, you have the federal government picking up 2/3rds of the total tab for health care in this country. It just does so in an inchoate, nonsensical fashion.
Some politicians, including former governor John Kitzhaber, argue for simply totaling up the money we already spend, then funneling it all into some sort of new, coherent program that could do much more for much less. After that, we could talk about new funds. Always seemed sensible to me, but the political life expectancy of someone suggesting an end to employer deductibility can be measured in moments. That said, if anyone has an argument for why we wouldn't be better off using this cash to fund an intelligently-designed, smartly-targeted program rather than the mish-mash of disconnected aims and historical giveaways we're currently pursuing, I'd like to hear it.
December 4, 2006 in Health Care | Permalink
Comments
It just does so in an inchoate, nonsensical fashion.
Kind of negates the meaning of 'health care system', now, doesn't it?
Given the rampant de-emphasis on prevention, how about 'medical treatment industry'instead?
Posted by: calling all toasters | Dec 4, 2006 3:14:54 PM
"Socialized medicine"!!!
"Hillarycare"
Shall I go on? Any plan as reasonable as the one proposed will lead to a limitless barrage of such statements. Mostly unchallenged by the media.
Posted by: zak822 | Dec 4, 2006 3:17:29 PM
"Shall I go on? Any plan as reasonable as the one proposed will lead to a limitless barrage of such statements. Mostly unchallenged by the media."
It's still something that should be proposed, as there is alot to be said for merely sparking debate over the idea.
And Ezra, I appreciate the Daft Punk reference (if that is what you were refering to).
Posted by: Jamelle | Dec 4, 2006 3:55:06 PM
Not to put an end the pity party, but you really shouldn't assume that Americans are not open to fundamentally overhauling the system. If your politicians aren't ready (fine), but maybe the solution is the same as what has generated the political blog craze- a shift toward creating grassroot efforts w/ voters rather than politicians. Of course, that would require a lot of work.
Posted by: akaison | Dec 4, 2006 3:56:22 PM
That said, if anyone has an argument for why we wouldn't be better off using this cash to fund an intelligently-designed, smartly-targeted program rather than the mish-mash of disconnected aims and historical giveaways we're currently pursuing, I'd like to hear it.
A mish-mash of disconnected aims and historical giveaways has a wide range of benefactees who can identify their interest in maintaining the status quo, and make political donations accordingly.
Posted by: Phoenician in a time of Romans | Dec 4, 2006 3:57:26 PM
i'm surprised at your relatively kind take on kitzhaber - what i always figure his approach means in practice (on net) is taking money away from Medicare and parsing it out to younger folks.
and, i'm not convinced he'll be there for the second fight where we try to get more public money for health coverage.
joshb
Posted by: joshb | Dec 4, 2006 5:07:25 PM
It's always good to remember that even when you don't count tax expenditures, the US has the highest public spending on health care in the world.
Posted by: Alon Levy | Dec 4, 2006 5:50:18 PM
If every employeer contributed half of what they pay currently for their employees and their families to private health insurance companies, we could cover everyone in the country with basic healthcare services.
Posted by: bones | Dec 4, 2006 7:18:26 PM
I think the way you describe the situation, Ezra, is exactly the right way for others to do it. You'll still hear from people - even Democrats - that "Universal health care is great, but it's such an expensive program." Completely wrong! But that's what a lot of people think. These examples are all from a two-month period of time in Wellstone Country this year:
“How can we get more people covered by health insurance without the cost being prohibitive?”
--A delegate question to Democratic U.S. Senate candidates, Minnesota DFL Convention, June 9, 2006. This was from a Democratic activist!
How do you pay for something like that? I mean, that’s always been an issue, that when folks say, let’s get universal or single-payer health care, other folks say, “Well, how are we gonna pay for this?”
--Question from a reporter to House candidate Keith Ellison, June 26, 2006.
“You’ve all stated that you would support universal health care, but it’s a massive program. How are you going to pay for it?”
--Question from the audience at a Jewish Community Relations Council candidates forum in Minneapolis, July 26, 2006.
One thing I've noticed is that a lot of universal coverage advocates like to talk about fixing the system like they are creating a new program: "single-payer" or "Medicare For All" or "drug benefits" or "covering all kids" or "covering small employers", etc., etc., emphasizing all the new features such a system would bring. That's fine, but I think the first thing anyone should emphasize is the cost. When discussing specific reforms, begin sentences on the subject with "Here's a way we could save money..." and spell out concisely exactly how it would do so.
It's not a silver bullet solution, but I think it would help change the perception a bit, and also help the movement prioritize which steps it wants to take next in getting us to universal coverage.
Posted by: Chris | Dec 4, 2006 11:11:56 PM
You need something to start the ball rolling. Some universal coverage system that offloads some slice of health care coverage off the current ramshackle system.
That needs to be based on a Health Care Commission system in which treatments proposed must justify themselves in terms of health benefit provided per dollar.
Providing universal coverage of what is covered, combined with a health-benefit per dollar filter, will take the load off each element of the ramshackle system.
* It will be prior coverage for some, even if not all, of the unfunded care provided in emergency rooms, reducing hospital cost shifting
* It will reduce the cost of whatever local clinic system is being provided by a municipality or state
* It will reduce the cost of providing any given employee based health care. Whether or not that cost reduction is recovered by the employer from the insurer is a separate question, but to the extent that it is, it will reduce the tax-cost of health care deductions.
* It will reduce the cost of providing the current Medicare and Medicaid coverage.
* It will reduce the cost of providing the current VA coverage.
* It will reduce the cost of providing any state based solution, whether a funded program or an employer mandate.
For each part in the current ramshackle system, it will reduce the load on the system, and do it in a way that rewards cost-effective provision of health benefits over demand-creating provision of health benefits.
I'd say fund the Commission out of the general budget, start the coverage fund with a 1% payroll surcharge, on the employee side of the fictitious divide between employer/employee "contribution", and just start doing it under the label "Medicare Universal".
The system that the largest number of health care providers
Posted by: BruceMcF | Dec 5, 2006 8:04:22 AM
Strike the last line (editing debris), add the note that this makes a start up fund of about $70b, at least until we get serious about putting payroll income taxes on all executive compensation.
Posted by: BruceMcF | Dec 5, 2006 5:55:29 PM
