Saturday, August 22, 2009
If you’ve been following this series, as legions of you have, you know that I’ve been arguing that the President and Congress should give up trying to craft a single, all encompassing piece of healthcare reform legislation in favor of writing new law on each of the major healthcare reform issues, separately. (If you want to know why I suggest this segmented approach, you need to take a look at “A Bits and Pieces Approach to Healthcare Legislation”, published August 19.) Regrettably, the President and Congress don’t read my stuff on a regular basis, so no luck so far.
Of the five healthcare reform issues I’ve covered, this is the hardest because the costs are potentially so high, because if there is one seminal reason for why we need healthcare reform legislation, this is it.
The first step should be a joint resolution which affirms the right of all Americans to some level of healthcare regardless of their financial means. To be clear, the implication is not the government should provide medical services to anyone. Far from it. I’m adamantly opposed to any government-provided services, including medical insurance. What the government should do instead is subsidize the cost of private sector medical insurance for those who can’t afford it.
In a previous piece on the subject (“Overcharging the Uninsured”) a briefly mentioned that the government might offer a form of guaranty, like mortgage insurance, to underwrite the payment for healthcare services by people who are uninsured. In fact, for what I think are obvious reasons, I’d prefer that everyone be covered by a minimum standard policy. By far and away, making sure that everyone has medical insurance, including the 40 to 50 million Americans who currently don’t, is the most administratively efficient, cost effective and otherwise desirable means of accomplishing universal healthcare.
How much will it cost to provide insurance for the uninsured.? Well, I don’t know. What I do know is that the first thing we need to do is define how and by whom this minimum standard should be derived, and then what this minimum standard should initially cover. This is the proper role of government. Bring together experts from the healthcare and underwriting professions to determine the standard policy we will define as the minimum coverage everyone will have. If the Administration and Congress have already defined this standard policy, my apologies. I’ve obviously missed it. In fact, I think they’re so lost in space in their glorious pursuit of a single piece of comprehensive healthcare legislation, that they’ve missed the most obvious point. You can’t tell how much something is going to cost until you know what it is you’re buying.
What is the minimum policy we want everyone to have? What is the private sector cost of this coverage? How many of our citizens will need how much help subscribing to that coverage? And now, only now will we know how much universal healthcare will cost. Yes, of course, we’ll need to take into account the savings from new government regulations which mediate non-competitive influences that have kept prices above competitive levels. The good news is that breaking down healthcare reform into its core components will make defining and estimating the effects of these adjustments all that much easier when we write the law on this particular issue.
“Check please! …Oh, my God!! Waiter, is that a real number or were you doodling?!” Yes, it’s going to be one hell of a bill. Lots of zeros. Which we’re going to pay for how, exactly?
The good news is that we can start by subtracting the costs we’re already incurring to provide healthcare for the uninsured. How much would we save, in other words, if everyone had adequate coverage? Figure that out, and subtract it from the cost of the program. What’s left we’ll cover either by new taxes and/or by cutting back somewhere else. Personally, I believe in doing whatever it takes, that universal healthcare is that crucial to our society and economy – provided we balance the budget which I’m pretty sure is a concept we’re going to have to explain to President Obama and many Democrats in Congress v e r y s l o w l y. There will be heated debate, but at least that debate will be focused on this specific question rather than confused by the myriad of issues the President and Congress are attempting, in vain, to resolve all at once.
Addressing these five issues I’ve covered, with individual legislation, turns out to have an extra benefit I hadn’t anticipated when I first made the suggestion. That benefit is in all the issues, programs, agencies and government, pardon me for saying so, “crap” that single issue legislation hasn’t covered. We’ve passed 5 laws which have redefined healthcare in America. There’s more we could have done, but major systems need time to transition, something President Obama doesn’t understand. The “bits and pieces” approach allows us time to adjust, to make corrections, to understand implications that we didn’t anticipate. I like the approach almost as much for what it doesn’t try to accomplish as for what it does.
Bit and pieces, ladies and gentlemen, one issue at a time. This notion of comprehensive healthcare legislation is making a mess which may just cause more problems than it solves. President Obama’s notion that some healthcare reform is better than nothing is poor management that smacks of Presidential inexperience and arrogance the American people can’t afford. I understand why the Democrats put up with it, but the Republicans? This is their chance to demonstrate reasoned, intelligent, mature leadership through an alternative approach to the problem. Unfortunately, it’s an opportunity they seem hell bent on wasting.
If you’re interested, here are some related posts…