Green Room

Getting Real About Health Care Reform

posted at 4:41 pm on March 20, 2012 by

by Libby Sternberg

The traditional second anniversary gift is cotton, so as the two year mark of the signing of ObamaCare comes around, I suggest a sock…to “stick in it,” perhaps,  as its champions celebrate.

Maybe the best gift of all, though, would be a realistic discussion of health care reform possibilities and consequences.

Don’t sweat, I’m not about to go into a complicated discussion of economic and financial computations that will make your eyes glaze over faster than high-fructose cola spilling at a child’s birthday party. I’m going to talk purely from the perspective of the average consumer of healthcare, the ordinary ondividual (ACHOO). (Yes, I know how to spell “individual,” but it didn’t fit my acronym.)

When ACHOOs think of health care reform, they are envisioning two freedoms: freedom from cost and freedom from worry. In other words, they don’t want to lose everything they own to pay off bills should a health crisis afflict them, and they don’t want to worry about care not being available for them during said crises.

President Obama and the Democrats promised ACHOOs these freedoms: keeping costs under control while keeping health care available (remember the “you can keep your own health plan/doctor/performance artist healer” lie?). They’ve doubled down on the first part of this deal by requiring insurance companies to cover things not all of them covered in the past (contraception), thus advancing the false impression that if you’re not pulling the cash from your wallet at the precise moment of a transaction, it’s free.

While Democrats played the free-from-worry card, Republicans offered…uh…um…wait a sec, it’ll come to me….

Well, we all know it was a roundup of the usual reform suspects: health savings accounts, tort reform, divorcing health insurance from employment, searching for ways to save “unnecessary” expenditures in the last months of life, electronic medical files that will result in miraculous efficiencies, more emphasis on prevention, and other stuff.

But, speaking as an ACHOO myself, every time I heard or read of one of these ideas during the Great Debate, I couldn’t help rolling my eyes so hard that I needed to consult an in-network ophthalmologist. You see, those who have had any contact with the health care system in any meaningful way—and trust me, I have—know in their gut if not in their heads that those ideas might nibble around the edges but won’t solve the problem entirely.

Tort reform, for example, supposedly would lead to less defensive medicine being practiced and unnecessary tests being ordered. Huzzah to that idea! But most ACHOOs want a doctor who would order an MRI rather than give them a highly educated guess. Sure, it’s great if tort reform lowers malpractice insurance costs, which in turn lower general costs altogether, but by the time those savings trickle their way down to the ACHOO level, we know we’re talking small savings at best.

Health savings accounts, too, are great ideas, but ACHOOs understand that only an account as large as Croesus’s treasure can cover the serious expenditures. HSAs are valuable for the little, everyday stuff, yes. But not for big things like the Big C.

And then there’s preventive medicine, a common ground for both the left and right. We ACHOOs might not have degrees in actuary science, but even we can figure out that a bunch of preventive care, with its more frequent checkups and tests, is actually going to add to the overall bill in many cases, not decrease it. We also know that many serious diseases simply can’t be prevented.

Then there’s one of my personal favorites, the “we spend most of our health care dollars in the last months of life” proclamations that seem to imply we should pull the plug on Granny when she’s going in the hospital for the third time in as many years. ACHOOs are not prescient, even if politicians think they are. Because we don’t know the precise moment our loved ones will exit this life, “excessive care” is something judged accurately only in hindsight.

I could go on, but the point is that ACHOOs aren’t stupid, and maybe conservatives need to recognize that and take a more Chris Christie approach to talking about health care reform. That is, be brutally frank. The hard truths are these:

Health care is expensive because we have so much of it available now to buy. (To which many with serious conditions would say, “Thank God.”) We can introduce reforms that will lower costs here and there, but this means bringing them down from, say, a gajillion to merely a jillion dollars, as long as we have so many high-tech treatments at our fingertips for the many serious conditions that still confront us.

If you want to make it cheap, you have to either buy less of it (rationing, if the government controls it) or force providers to accept lower payments (which would eventually lead to rationing). So, while you get rid of Fear #1 (bankruptcy due to high health costs), you’re stuck with Fear #2 (less availability of the care you need).

In other words, there’s no free lunch even in “free” health care.

Accept the fact that it’s expensive. Look for efficiencies and tweaks to lower costs here and there. Advance ways to make insurance (which is, after all, supposed to take away Fear #1) more portable.

And while doing all those things….cure cancer and heart disease. I am not kidding.

What no one talks about is what every ACHOO knows because these scourges touch virtually all families, depleting savings and accounting for the largest portion of health expenditures overall. Put more money into research and treatments for the Big C and its companion killer, heart disease, and health care costs would go down eventually at a precipitous rate.

Think that’s silly? Tell that to the millions who feared polio in the last century and breathed a sigh of relief after Salk and Sabin released their vaccines.

Get real about health care reform, conservatives. And be honest with Americans. They can take the diagnosis and soldier through the tough remedies.


Libby Sternberg is a novelist who blogs about political issues at Center Right Side blog. Her book website is here.

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I got a plan to take care of that sneezing problem you seem to be suffering. Come right over here to the free clinic, and Dr. Kvorkian will be right with you.

Right_Mike on March 20, 2012 at 5:57 PM

Libby, your points are valid, but from the perspective of the provider, here are a couple of issues we’re staring at…

Cure cancer and solve heart disease:

Most of the research money out there is being spent specifically on cancer. We’ve got innovations moving as quickly as they can, but as long as we still have the FDA throwing up roadblocks that take drugs and treatments the better part of two decades to get to market, we’re no closer to being able to fix these problems. In the meantime, it doesn’t cost any less to be a doctor these days. We could solve these diseases today and you wouldn’t see a treatment get to market until the middle of the century.

In the meantime, all the money that’s going to “sexy” diseases to treat means that that money isn’t going towards equally critical issues like newer and more effective antibiotics. We now have issues with diseases we’d eradicted in the US coming back to bite us, and these evolved bacteria are resistant to many of the antibiotic greatest hits (the penicillin family, in some cases the quinolones like Cipro).

My point is that many of the scientific advances you’re asking for are made much more difficult by the sheer volume of overhead we have to pay to practice medicine. For the few of us left in private practice, we literally have to buy a person trained in federal compliance to steer the practice through the federal minefield. Those people aren’t cheap.

Again, I hear where you’re coming from, but we can’t make health care cheaper at the provider level when we can point to so much overhead-increasing regulation that is at best superflous.

tmi3rd on March 20, 2012 at 10:03 PM

1. We need to figure out a way to separate health insurance from an employer. Too many people are in jobs they don’t want and can’t start their own business because of health insurance considerations.

2. If people don’t have insurance, doctors and hospitals get “stuck” providing services for folks for free. This means the cost of services goes up and we end up paying for them anyway.

crosspatch on March 21, 2012 at 12:48 AM

tmi3rd and crosspatch, I agree with you both. I especially agree with your points, tmi3rd, about the high cost of bringing new treatments to market and the FDA’s roadblocks. Don’t get me started on the Avastin issue…

I realize that I was being a bit glib with my “cure cancer” prescription. My broader point is that politicians have to stop promoting the idea that any one reform is going to bring costs down to a degree that the average consumer will feel a significant change when facing serious health problems. In other words, cancer treatment will still be very expensive, even with tort reform and the like. That doesn’t mean we shouldn’t enact those reforms. I just think we need to set realistic expectations.

As to finding ways to separate health insurance from an employer — absolutely agree.

Libby Sternberg on March 21, 2012 at 4:56 AM

A health savings account is paired with a high deductible major medical insurance policy. You pay minor medical bills out of your HSA, and it covers the high deductible when you have a really bad year.

HSA’s are the best way to shift away from employer provided health insurance.

fadetogray on March 21, 2012 at 8:21 AM

You have a large group of people who think you can have the best healthcare in the world, coverage for everything, near unlimited access, and lower costs. That IS stupid.

SAMinVA on March 21, 2012 at 12:34 PM

Deregulate the health care industry. Unless we do that, costs will continue to soar.

J.E. Dyer on March 21, 2012 at 1:12 PM

Various commenters have addressed, in one degree or another, the point I’m trying to make. You can lower costs with various reforms, yes. But you can’t make health care free or even what most people think of as “cheap” without addressing the serious illnesses that require large expenditures for treatments. I believe Republicans make a mistake by implying their reforms will accomplish what the Dems falsely promised. It’s better just to tell the truth –yes, health care can cost less, but it’s never going to be cheap, and it’s never truly going to be free without grave consequences in availability of care.

Libby Sternberg on March 21, 2012 at 2:03 PM

I hope that sock is a dirty sock.

In the meantime, we need to get the government out of the way when it comes to insurance, allowing people to buy just the coverage we want. It would also be good to change the intellectual property laws in a way that would smooth the price transition from proprietary to generic, perhaps by extending IP protection in exchange for licensing the production to multiple producers in exchange for a fixed (and declining) cut of the gross sale.

Finally, narrowing the FDA’s scope and making it harder to ban a drug (a opposed to black-boxing it) would help a lot of people.

njcommuter on March 21, 2012 at 7:49 PM

Deregulate the health care industry. Unless we do that, costs will continue to soar.

J.E. Dyer on March 21, 2012 at 1:12 PM

Bingo. Libby, the trouble with your argument is that no entity currently involved in the health care industry has any internal incentive to bend the cost curve down. Zero, zilch, nada.

Only free market forces can drag them kicking and screaming into a reality based economic model. I am not expecting health services to be free any more than I would expect my housing and groceries to be free, but I do expect a fix for the current highly distorted health care market.

Difficultas_Est_Imperium on March 21, 2012 at 10:37 PM

Difficultas…I’m for introducing more market pressures into the health care arena. But I do not believe even that will SIGNIFICANTLY reduce costs for the big problems. That’s because there are different motivations at play in the health care field than in the true free market. You might forgo purchasing a good or service (or find a suitable alternative) if you don’t like the pricing in the free market of goods and services. When you’re staring a serious health problem in the face, you reach for the best treatment, danged the expense. The polio example illustrates this problem. Parents of polio victims went through their savings and did whatever it took to care for their children. There is a poignant letter from one such parent to FDR, the father saying he’d give his last penny to take care of his child, but he sure hoped they found a cure for the disease soon. They found the vaccine, sparing other parents those devasting costs of care. It’s important to remember that the costs were high, despite free market pressures on the system at the time. My point is that Republicans shouldn’t be like Democrats, promising people significantly lower costs that can’t be delivered. Yes, introduce more free market pressures and all the other reforms mentioned, but don’t overpromise.

Libby Sternberg on March 22, 2012 at 6:24 AM

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