We'll cover everyone by covering less?
Posted: Dec. 9, 2009
Now, said the Senate to us sheep, we'll do health care this way: No public option. Just a, um, public option.
Senate Democrats' leaders, looking to pass something, on Tuesday night dropped the notion of a government-run health plan. Too many of their less liberal members recognized a money pit when they saw one. Instead, the plan is to let more middle-aged people join their elders in Medicare.
Uh, guys: Medicare is government-run. It's eight years away from fiscal ruin, its own trustees reported earlier this year. This deal trades a dysfunctional plan for a laughable one.
It also reveals the futility of Obamacare reaching one of its key goals: slowing the rise in health care spending. Congress' plans all do this in part by cutting Medicare by as much as a half-trillion dollars. Now the Senate would put perhaps 3 million more subsidized clients on that Titanic. There will be no cuts, only swifter collapse.
The more worrisome part is that even if Medicare weren't nearing doom, the president and his Congress have odd ideas about bending the cost curve. So far, the cost measures all aim to restrain how much all of us together spend on health care. Independent studies say Congress fails even at this, but that's another column. At any rate, whether Washington spends less overall isn't especially relevant to whether a hospital bill will bankrupt you.
Take those Medicare savings. Congress' bills all cut the rate at which the government pays doctors and hospitals for Medicare patients. Doctors already say, correctly, that they're paid miserably for this. Often, they lose money on the deal. In many places, it's hard for older people to find a doctor who will take Medicare.
Other ominous signs: The Obama administration already has empowered federal panels to study which treatments are cost-effective. The cost-benefit calculations have generally been in terms of expense to society as a whole.
Yes, but mammograms that catch breast cancer early, to pick one recent example, are immensely valuable to the particular women saved, say critics. They're swimming upstream: Advocates of the kind of health reform pushed by the president have warned repeatedly that individuals must be prepared to sacrifice for the common cause.
The president and his allies are not, in other words, seeking less costly health care. They're seeking to spend less. You can get the latter without the former; you just buy less care overall. HMOs did this in the 1990s by making it hard to see doctors. Infamously, socialized systems do it by waiting list, which is why towns in Ontario hold lotteries to see who gets doctor's appointments.
This is logical: It's ideologically simpler to pay doctors less than to deploy changes that make care a better value for individual patients.
This already worsens health care prices. Because they lose money on Medicare, doctors and hospitals make it up on privately insured patients. Meanwhile, since traditional coverage insulates patients from prices - quick, what's a check-up cost at your doctor? - there's no real pressure on prices. Thus, costs are ruinous for the uninsured.
What makes more sense is lowering the actual price of care. There are ways to do this; Congress embraces none of them. There's no lawsuit reform to ease the cost of jackpot justice, no opening of insurance markets to national competition.
Most of all, Obamacare, whatever form, increases the extent to which health care is paid for by someone else. This is the dynamic that makes those payers think about how to cut the budget overall, if necessary by telling patients to take the Tylenol and shut up.
The opposite approach is to put patients in control of the money spent for their own care. This fixes the incentives: You'll want good value, but not to the point of tolerating wretched care. Better, this arrangement - you, making your own cost-benefit trade-offs - has restrained how much the nation as a whole spends on other goods and services, from food to automobiles. It works for you and for society.
This shouldn't be hard. We're a smart country. All we need is for Congress to start thinking of us as functional adults rather than a single $1 trillion lump of budgetary burden.
Patrick McIlheran is a Journal Sentinel editorial columnist who blogs at www.jsonline.com/blogs. E-mail firstname.lastname@example.org