Marketplace Scratch Pad

Hope for health care?

Scott Jagow Jul 22, 2009

President Obama speaks to the nation tonight, and of course, one of the main topics will be health care. I’ve been reading, watching and listening — and trying to have hope for effective health care reform. But it’s difficult.

Take, for example, the discussion on the PBS NewsHour last night. Judy Woodruff interviewed four Congressmen. They all have different ideas about how to pay for health care reform. Senator Chris Dodd (D-Conn) talked about “shared responsibility”:

You’re going to have to have employers — we want to keep them in plans. But with people who employ more than 25 people, they have the choice of providing the health care coverage or paying into a system — in our bill, $750 for a full-time employee, $350 for a part-time. That’s $2 a day.

You can call that a tax or a fine, if you want. But that’s the sort of shared responsibility we’re going to have to have if you’re going to achieve access, if you’re going to achieve reduced costs and bring more people into the program.

Senator Lamar Alexander (R-Tenn) thinks Congress should start over from scratch with a focus on shifting costs:

What it does is basically you take the subsidies that we’re now giving to Americans for health care and rearranging them in a fair way so that everybody could have a policy, could afford a policy that would be about like what congressional employees have.

But what we have instead is a bill Senator Dodd said added $631 billion to the deficit over 10 years, but he didn’t count all the people who are going to be dumped into Medicaid, and that would make it more like $2 trillion over 10 years, if the program’s fully implemented.

In the House, we have Rep. Jim Cooper (D-Tenn) who says health care reform can be paid for entirely by cutting out waste:

We’re estimated to waste about $700 billion a year in payments that not only don’t improve our health, but actually sometimes harm our health. So we should go after those savings. “Overtreated,” the book by Shannon Brownlee, the Dartmouth work, the McKinsey data have pretty much proven the $700 billion.

JUDY WOODRUFF: So all in savings? You think that’s realistic?

REP. JIM COOPER: Yes, absolutely.

Cooper’s colleague across the aisle, Rep. Paul Ryan (R-Wis) is in the same camp there:

We already spend more than 2.5 times per person on health care in America than any other country. We’re spending lots of money. Let’s spend that money more efficiently and more effectively than raising all of these new taxes, borrowing all this additional money to put on top of the $5 trillion our government is already projected to spend over the next 10 years for the under 65 population.

You’d like to think the solution could be cutting out waste, but Dodd makes a good point in basically saying that this stuff isn’t going to magically disappear.

David Leonhardt has an excellent piece in the New York Times noting the challenge the President faces in trying convince many Americans who are probably asking, what’s in it for me, besides higher taxes?

Our health care system is engineered, deliberately or not, to resist change. The people who pay for it — you and I — often don’t realize that they’re paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with.

The doctors, hospitals and drug makers use the money to treat us, and we of course do see those treatments. If anything, we want more of them. They are supposed to make us healthy, and they appear to be free. What’s not to like?

Leonhardt says, for starters, how about looking at what Americans are getting for their money?

The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average…

In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical.

One thing we don’t get is better health than other rich countries, whether it’s Canada, France, Japan or many others. In some categories, like emergency room care, this country seems to do better. In others, like chronic-disease care, it seems to do worse. “The fact that we spend all this money and don’t have better outcomes than other countries is a sign of how poorly we’re doing,” says Dr. Alan Garber of Stanford University. “We should be doing way better.”

But NPR has a story about 10 communities in which health spending is lower than average and health care outcomes are better than average. Doctors and hospital officials from those places just met in Washington:

“Eliminating unnecessary care is not rationing,” (Elliott Fisher of Dartmouth Medical School) said. “Who among us wants to go see a physician when we could have stayed at work or stayed at home? Who of us wants to go to the hospital when we don’t need to be there? These communities have shown us that it’s possible to avoid that unnecessary care, and that’s not rationing.”

One of the more hopeful messages that Harvard surgeon Gawande took away from the daylong meeting was that change can happen relatively rapidly. “Half of these communities used to be high cost and transitioned to low cost over the last decade. So they made me hopeful that we could do it” as a nation,” he said.

I’m glad somebody’s hopeful. If these 10 communities can do it, it does seem possible that health care could be more efficient on a national level. It’s just that Congress seems seriously divided on how to achieve this.

What about you? Are you engaged on this issue? Do you see an outcome that might work for you personally AND expand coverage?

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