Getting Real About Health Care Reform
posted at 4:41 pm on March 20, 2012 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.