Felicia Muftic – Waiting to refrom health care is not an option
September 27, 2009
Who is a fiscal conservative in the health care reform debate?
Soothingly, Republicans say we should wait until the economy gets better. What they really mean: Let’s wait until we can get more Republicans in Congress in the mid-terms so we can really defeat this sucker and then we can deal with it our way.
It will take another 10 years to get all of the reforms in place, so if we do not start now, when should we start? Do we wait for future shock until insurance premiums are unaffordable for two times the number of American families as now and health care costs destroy our economy? Or do we get what Obama is saying in so many words: a stitch in time saves nine?
The economy is improving somewhat on the time schedule predicted by the Obama finance gurus last February. With Obama’s signature on the legislation by December, the timing should be about right. Waiting for the economy to improve is a Republican argument that will hold little water by next summer.
Can we afford to pay for health care reform? Len Nichols, economist with the centrist, non-partisan New America Foundation, told Colorado Medical Society conference attendees recently: ” 30 percent of what we spend on health care does not improve our health … Even maximum spending for health care reform anyone has proposed ($1.6 trillion) is less than 1 percent of our GDP.” Obama cuts that figure almost in half, at $900 billion over 10 years, about $600 billion of which comes from identified savings, verified by the Congressional Budget Office. The rest is no free lunch but it is do-able. Obama has vowed to veto any bill that adds to the deficit now and in the future. His “pay as you go” is a fiscally responsible approach.
Do you think a future Republican-dominated Congress will buck their insurance company buddies to enact effective health insurance reform? Get real. They are selling us a used car “as is” and with a track record of opposing any controls by competition or otherwise on health insurance premium price, now increasing by 5.5 percent over the annual rate of inflation.
If they succeed, seven years from now, you will devote nearly half of your income to health insurance. Many of you or your employers will probably drop insurance benefits or, to pay premiums, you will either starve or not pay the mortgage. Nichols predicts “families will find their insurance premiums have increased from 17 percent of their income (2006) to 45 percent of their take-home income in 2016.” You may join the other 37 million who already seek care in the ER, passing the $1,000 extra per year ER medical care costs to the few left who can afford insurance.
Nichols brings it down to earth: The pressure to increase taxes or cut benefits in the future will be extreme because our entire economy and individuals will be in unsustainable straits. Medicare and Medicaid, according to Nichols, will eat up our nation’s gross domestic product, rising in 10 years from 4.5 percent to 7.3 percent. Per the Congressional Budget Office the two programs will grow to 10 percent by 2035 and by 2080 will account for 90 percent of spending growth.
Obama’s plan will indeed cut out the boondoggle Medicare Advantage provided private insurers, saving $177 billion. Medicare Advantage was enacted in 1997, allowing seniors to combine Medicare and supplementals with one payment to a private insurer. The private insurers then charged the government 14 percent more to administer Medicare than it cost the government to do the same, and no one is healthier. The 20 percent of seniors on the plan will see one change: They will have to buy supplementals separately, just as they did before and the 80 percent on Medicare already do. Obama’s plan will not hit the Medicare trust fund or cut benefits.
The Republicans are throwing concerned consumers a bone with little meat on it with “alternatives” that do little to reduce the cost of ER medicine, as they ignore insuring the uninsured or propose underinsurance for all. Their other “alternatives” only tweak the cost curve, but give it no significant bend. It is not dramatically noticeable that tort reform already enacted in 35 states caused any reduction in physicians prescribing unnecessary tests. Changing human behavior to go on a diet or stop smoking takes years. As smoking ban, helmet law, and seat belt scoffers have shown, even with insurance incentives, risky behavior changes slowly. Buying insurance across state lines may be helpful, but the same few national insurance companies dominate nearly all states, making any semblance of competition a farce.
Today the Congressional Republicans have an easy, but irresponsible message: Just say no. Obama has a harder, but more responsible case to sell: Fix it now when it is still manageable or face some painfully extreme measures later.
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