Free Lunch
The Commonwealth Fund recently released a brief comparison of several plans under consideration in Washington for changing health insurance. The plans can broadly be divided into those that expand on existing government programs and those that expand on existing employer based plans. In one sense, it’s the proverbial balloon--when you push down a cost here, it pops up somewhere else. No free lunch in these plans. For example, mandating the provision of health insurance by employers would reduce the number of uninsured. But it would also reduce Medicaid and SCHIP rolls, thus shifting this cost to employers. Similar concerns exist for other approaches, because the “uninsured” are not a homogeneous group. Some are unemployed, but some are not. Some are poor, but some are not. Any plan that focuses on “the uninsured” will, like a Dick Cheney shotgun, strike unintended targets.
Of course, no one wants to talk about costs, or more specifically, where the money will come from. Buying health insurance for America’s uninsured is going to cost money. Lots of money. Several plans point to “administrative savings” and reference the low administrative costs for Medicare relative to private health insurance. Now, someone will have to help me out here. I work for the federal government, and they’re constantly talking about privatizing some or all of my office. Now, you’re talking about de-privatizing the health insurance industry. What am I missing? Does anyone really believe that Medicare does it cheaper? Or is this another urban legend? One way to cut costs, of course, is to just not provide the service. Ever try to call Medicare? (When you’re real bored, it's 1-800-MEDICARE.)
One problem with all approaches to reforming health insurance is that they attack the wrong target. It’s a worthy goal to help the uninsured, but a recent ASQ/Harris poll showed that most Americans are worried about the high cost of individual healthcare services, not the uninsured. Yep, healthcare costs even edged out the Iraq war as a cause for concern. None of the proposals under consideration will affect those costs. Furthermore, all will increase the total amount of money spent on healthcare in this country.
There is some suggestion that improving the efficiency of healthcare by focusing on cost of individual services could save enough money to finance healthcare for all the currently uninsured.
It seems likely that something will be done to provide health insurance for some of the uninsured. The debate will be on relative costs and who will pay. No one realizes they could have it all for free.
Of course, no one wants to talk about costs, or more specifically, where the money will come from. Buying health insurance for America’s uninsured is going to cost money. Lots of money. Several plans point to “administrative savings” and reference the low administrative costs for Medicare relative to private health insurance. Now, someone will have to help me out here. I work for the federal government, and they’re constantly talking about privatizing some or all of my office. Now, you’re talking about de-privatizing the health insurance industry. What am I missing? Does anyone really believe that Medicare does it cheaper? Or is this another urban legend? One way to cut costs, of course, is to just not provide the service. Ever try to call Medicare? (When you’re real bored, it's 1-800-MEDICARE.)
One problem with all approaches to reforming health insurance is that they attack the wrong target. It’s a worthy goal to help the uninsured, but a recent ASQ/Harris poll showed that most Americans are worried about the high cost of individual healthcare services, not the uninsured. Yep, healthcare costs even edged out the Iraq war as a cause for concern. None of the proposals under consideration will affect those costs. Furthermore, all will increase the total amount of money spent on healthcare in this country.
There is some suggestion that improving the efficiency of healthcare by focusing on cost of individual services could save enough money to finance healthcare for all the currently uninsured.
It seems likely that something will be done to provide health insurance for some of the uninsured. The debate will be on relative costs and who will pay. No one realizes they could have it all for free.
