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Sunday, 28 February 2010

The Cost of Doing Nothing About Health Reform

Reed Abelson's article in today's New York Times should be required reading for all those who want to put the kibosh on the reform process.

Here's the opening of Abelson's excellent piece:
“Hands off my health care,” goes one strain of populist sentiment.

But what if?

Suppose Congress and President Obama fail to overhaul the system now, or just tinker around the edges, or start over, as the Republicans propose — despite the Democrats’ latest and possibly last big push that began last week at a marathon televised forum in Washington.

Then “my health care” stays the same, right?

Far from it, health policy analysts and economists of nearly every ideological persuasion agree. The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly or indirectly.

“People think if we do nothing, we will have what we have now,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit health care research group in New York. “In fact, what we will have is a substantial deterioration in what we have.”
In ethics classes we teach that hiding from serious moral issues is a quick route to catastrophe. That's the path we're on. The evil of pushing more and more of our population outside the insurance system, and our cowardly acquiescence to the cancerous growth of health care costs, are like the tectonic plates that eventually cause the kind of massive earthquake we've seen in Haiti and Chile.

One of the attack dog critiques of the Senate and House proposals is that they will lead to rationing, and rationing is wicked. The real issue, of course, is whether we ration in a clinically informed, ethically guided manner, or do it the way we do now, by leaving 50 million outside of the insurance system. Rationing is an ethical requirement for every modern health system. The only question is whether it is done in a fair manner.

The Republicans have done a very effective sabotage job on the administration's efforts. They will probably win some short term political advantage from their "just say no" approach. But the continuing deterioration of our health system and the impact of the health care cost cancer on wages and other societal objectives, will - paradoxically - ultimately lead to much more radical interventions than the current proposals embody.

As costs go up insurers will push harder to control them. But given the degree to which we've demonized the insurance industry, insurers won't be accepted as legitimate sources of cost containment and rationing. I expect that we'll see some of the for profit companies exiting from the business when their margins and stock prices go down. And since for the moment we've rejected the kind of honest thinking about limits that Oregon Governor Kitzhaber introduced 25 years ago, we'll just ratchet down reimbursement, which will scuttle many of our most needed but most vulnerable provider groups.

So here's my prediction. If the Republicans and the Tea Party folks succeed in blocking any meaningful efforts today, we'll see costs and discontent rise steeply. If the Republicans succeed in making Obama a one term president 2012 they'll have a chance to apply their non-ideas. These will fail. The situation will deteriorate further, and after the 2016 election the country will stagger into some form of universal coverage.

As Winston Churchill predicted - "The Americans will always do the right thing... after they've exhausted all the alternatives."


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