The Brass Tack

Let's get down to it.

Yes, we need to bring down health costs

Posted by srconstantin on August 5, 2009

There are those, like Kevin Drum, who think this compromise Senate health bill isn’t so bad after all. The point, says Ezra Klein, is that that at least it’s covering more uninsured people, even though there’s no public option. “What has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured. ”

Matt says something similar, that “On paper, and pretty much in reality, it will achieve universal coverage,” but “Besides IMAC, there won’t be any good price control or delivery reforms” and that it will still be the “greatest domestic policy accomplishment since the Johnson administration.”

I’m with Matt on his predictions, but I disagree with all of them on their positivity. After all, the moral case for health reform isn’t outrage that citizens aren’t insured on paper, but outrage that citizens can’t get medical care except at the emergency room. I don’t believe that poverty or pre-existing illness should, in the richest country in the world, bar so many people from getting medical treatment. But if we want to change that, we don’t just have to make sure everyone’s insured on paper, we have to make sure everyone gets adequate medical treatment. And for that, we’ll have to bring down prices, or health care will still be “rationed” in another way (if not by high insurance premiums, then by long waiting times.) Or, as Tyler Cowen says,if we don’t solve the costs problem, in egalitarian terms things will only get worse, no matter how many people we cover.

The cost-saving measures were my favorite part of the plan. Things like changing how doctors are paid to reduce unnecessary procedures; making unified electronic health records to reduce billing costs and duplications; and the public option itself, which probably would create some competition and lower insurance costs (though it’s better understood as undercutting insurance prices and thus being a public subsidy for health care.) I actually talked to someone the other day whose job is improving electronic health records with cloud computing; your internist would have a record of all the other specialists you see, and it would be possible to simultaneously pull data from all the doctors associated with one person, reducing duplication and the kinds of problems that arise when prescription medicines don’t go well with each other. If you reduce the cost of health care (and there’s a lot of fat in the system to reduce, since more spending often doesn’t correlate, state-to-state or country-to-country, with better health) then more people can get decent health care. If you don’t, then we might just have shortages (of things like supplies and family physicians).

Maybe Matt’s point is valid as a political one. If we can just change health care from a private good to a public one — if people can become as comfortable with publicly subsidized health care for all as they are with the idea of public schools — it will be a major political victory. But if costs keep rising as they are, the health plan as it sits now may wind up insolvent or toothless.


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