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The Healthcare Two-Step
Ezra Klein says that Tyler Cowen has a point when he argues that we're running the risk of enacting a healthcare bill without effective cost controls:
But it is baffling to watch him blame this on the Obama administration. As he himself says, the White House is firmly behind the most promising proposals on cost....What stands in the White House's way is Congress. And, more often than not, it's the Republicans in Congress.
Liberals, after all, will sacrifice almost anything to radically expand coverage. This leaves cost-conscious conservative facing a bit of a dilemma. They can attack the most vulnerable parts of the policy — the cost controls — in the hopes of bringing the whole thing down. The downside to that, of course, is that liberals simply jettison cost-controls to protect the coverage expansion. For a fiscal conservative, this should be considered the worst of all worlds.
I don't know about Tyler specifically, but this is par for the course for conservatives in general, who basically have two critiques of national healthcare plans. First, they yell and scream that we're busting the budget if cost controls aren't firm enough. At this rate, healthcare will be 99% of the federal budget by 2050! But then, if you concede the point, they yell and scream that your cost controls are rationing medical care. Do you want to stand in line for months just to get a flu shot, the way they do in all those European hellholes!?
Conservatives can bounce back and forth between these mutually hypocritical positions pretty much forever. Why? Because they're effective. The first makes earnest liberals feel guilty because we basically agree as a policy matter. The second is the greatest public argument against national healthcare ever invented, regardless of whether or not it's actually true. The combination of the two has won the day for conservatives for decades. Why give up a winning strategy now?
all hands on deck
Republicans in the 30s didn't want Social Security or Medicare either, and both programs were established in spite of Republican demonization. We need to push this through now in the same way, with a robust public option. It's disconcerting that present-day Repubs (like their great-great grandfathers) want to destroy the most effective programs for social well-being ever conceived in America, but say a prayer and pass the ammunition. This will only happen if Democrats force it on the Republican minority, and we need to force our elected officials to implement the agenda we voted for in the last election. Otherwise, elections don't have consequences.
Worst of times, best of times
The downside to that, of course, is that liberals simply jettison cost-controls to protect the coverage expansion. For a fiscal conservative, this should be considered the worst of all worlds.
Quite the opposite.
If conservatives maneuver liberals into passing a very expensive bill, they can point to the enormous deficits and say, "See? We told you!" Deficits on the short term may be necessary. Over the long term, they're trouble and trouble begets electoral change.
It might actually happen this time, because...
the big population hump of the Baby Boomers is reaching the age at which the body's systems inevitably begin to break down. Many more of us are encountering the health care system up close and personal these days, much more than we did in our youth, and we're not liking what we experience.
Insurance comes first
Before agonizing over cost controls -- whatever that means -- we have to first make sure that (1) everyone is covered by at minimum catastrophic coverage, and (2) that everyone knows they can never, ever lose that coverage if they l,ose the job that currently offers coverage knows they are covered. If you achieve that, you assure doctors and other healthcare providers that they will be paid the lion's share of what the are owed, and will eliminate the enormous waste of the search for and fighting over pre-existing conditions, delays and haggling over finger-pointing about coordination of benefits, padded provider bills to cover potential delinquencies, finance charges for slow payments, and the army of provider administrators and collection infrastructure that now pollutes the system. With the right framing of the issues, the providers should be on our side: as much as anything, it's about assuring they will get compensated and freeing them up to do what they are actually trained to do.
What cost cutting measures do we want?
There have been a variety of things discussed or at least suggested. Which are the most appealing in terms of likelihood that they will really cut cots?
After all, when it's all said and done, YOU have to live with the results of this reform, so you might as well speak your peace about what you want it to be.
I suggest using more and more IT so doctors can doctor instead of administrate.
I suggest not letting insurers to interfere with a doctors & patient relationship.
I suggest covering more (if not all) people, so the cost/person can be spread out.
I suggest lowering med school student cost, so they have less reason to charge more later.
What are your suggestions?
Markh, "What are your
Markh,
"What are your suggestions?"
I suggest loosening the iron grip on the number of new medical school graduates every year.
Keeping the supply of Doctors low keeps their pay up but it also does some things most doctors don't like - the cost of medical school is huge, the competition to get into one is incredibly harsh, and then the graduates have to work like dogs as a payback.
I've heard from more than one older doctor who decries the overclocked turbocharged pace the doctors must keep these days.
One problem with a capitalistic system is it puts ALL of us in a hamster wheel where we are forced to go faster and faster just to keep up, and yet our own speed fuels the darn thing to greater speeds. I spent thirty years at IBM and every single year I was expected to improve by at least 10%. The expectation was codified and called 'constant improvement' and other names. Think about it. Do we expect an athlete to improve 10% every single year?! I think the rule of 72 would say I'd have to be 16 times better after 28 years, and that is simply unrealistic. My pay was not 16 times my starting pay, that is for sure.
The time may just be right for some Doctors (and other workers) to say they would accept slightly lower pay if it meant a lower work pace.
This freaking hamster wheel is of our own making and if we don't slow it down a bit we will simply accelerate until reality makes us slow down, probably due to the restrictions of natural resources.
Tripp