True, true, but not related
Rep. Paul Ryan (R-WI) writes an interesting comment on some estimates from CMS on future health spending. Much of what Ryan says is true, but the conclusions he reaches are not related to the facts presented. Perhaps this is another page in the Goehring-Bush playbook (“If you want people to vote for your war, make them feel threatened.”): Sprinkle your essay with enough facts, and people will believe all of it. First, he reiterates Sean Keehan’s projection that healthcare spending will reach 20 % of GDP in 10 years. OK. Maybe. Then, he blames “the tax code and entitlement spending” for this problem. Hmmm. That’s a stretch.
He states that most Americans rely on their employers for their health insurance, as if that’s obviously a bad thing. Ask yourself, who would be more interested in your health, your employer or the federal government? True, my employer pays part of my health insurance premium. True, I pay my Medicare premium (and yours too) thru payroll taxes. Now, if the feds are so good at providing health insurance, and I have Medicare, why do I need another insurance plan? (A rhetorical question.)
He alleges that the tax code causes employers to hide “the true cost of insurance” and this, in turn, “increases demand for covered medical services.” Here, he loses me. My pay stub clearly states how much of the premium I pay and how much my employer pays. And let me state here that I do not want any “covered medical services” this year. I may have need of something in the future, but I don’t want it. Have never seen a hospital offer frequent flyer miles. Actually, it’s against the law to offer sales or other inducements to Medicare patients.
Providers may be “induced” to suggest additional services if they know the patient has insurance that will pay, and this factor has been discussed here and elsewhere. Covering more individuals with health insurance will increase overall expenditures. True. Whether you look at this as “increasing demand” or permitting needed services depends on your politics. Probably some elements of both. As with SCHIP, when you raise the income threshold and bring more families into the program, you will include some who don’t need it. But the alternative is to exclude some who do. An arbitrary line.
Ryan offers three approaches to “controlling healthcare costs and expanding coverage:”
1. Personal Ownership. Not clear what this means, except an argument for eliminating the tax deductible status of employee health insurance premiums. I already feel like I “own” my health insurance. Not clear what additional “ownership” would be created by making me pay for it with after tax dollars.
2. Transparency. True, healthcare prices are opaque. But this only matters when those making the purchase decision know the price. So, why does Medicare pay widely different amounts to adjacent providers for the same procedure? Why doesn’t CMS shop for the low cost provider in an area and send all their business there? How would publishing prices affect my decision on where I go for healthcare that BC/BS pays for?
3. Entitlement Reform. He doesn’t say what this means, but one can assume (from the SCHIP debate) that he means reducing eligibility of individuals and services. HMOs tried limiting access to healthcare and were drummed out of town. Some have talked about means testing for Medicare and for SSA. Neither plays well on the 5:00 news. Another concept rears its head now and then--individual responsibility. (We don’t pay for healthcare needs brought on by personal habits.)
In ending, he states that “there is broad agreement on the problem.” Perhaps true. And “there is no agreement on solutions.” Definitely true. Any solution will require leadership and courage. That is, after we define what the problem is.
He states that most Americans rely on their employers for their health insurance, as if that’s obviously a bad thing. Ask yourself, who would be more interested in your health, your employer or the federal government? True, my employer pays part of my health insurance premium. True, I pay my Medicare premium (and yours too) thru payroll taxes. Now, if the feds are so good at providing health insurance, and I have Medicare, why do I need another insurance plan? (A rhetorical question.)
He alleges that the tax code causes employers to hide “the true cost of insurance” and this, in turn, “increases demand for covered medical services.” Here, he loses me. My pay stub clearly states how much of the premium I pay and how much my employer pays. And let me state here that I do not want any “covered medical services” this year. I may have need of something in the future, but I don’t want it. Have never seen a hospital offer frequent flyer miles. Actually, it’s against the law to offer sales or other inducements to Medicare patients.
Providers may be “induced” to suggest additional services if they know the patient has insurance that will pay, and this factor has been discussed here and elsewhere. Covering more individuals with health insurance will increase overall expenditures. True. Whether you look at this as “increasing demand” or permitting needed services depends on your politics. Probably some elements of both. As with SCHIP, when you raise the income threshold and bring more families into the program, you will include some who don’t need it. But the alternative is to exclude some who do. An arbitrary line.
Ryan offers three approaches to “controlling healthcare costs and expanding coverage:”
1. Personal Ownership. Not clear what this means, except an argument for eliminating the tax deductible status of employee health insurance premiums. I already feel like I “own” my health insurance. Not clear what additional “ownership” would be created by making me pay for it with after tax dollars.
2. Transparency. True, healthcare prices are opaque. But this only matters when those making the purchase decision know the price. So, why does Medicare pay widely different amounts to adjacent providers for the same procedure? Why doesn’t CMS shop for the low cost provider in an area and send all their business there? How would publishing prices affect my decision on where I go for healthcare that BC/BS pays for?
3. Entitlement Reform. He doesn’t say what this means, but one can assume (from the SCHIP debate) that he means reducing eligibility of individuals and services. HMOs tried limiting access to healthcare and were drummed out of town. Some have talked about means testing for Medicare and for SSA. Neither plays well on the 5:00 news. Another concept rears its head now and then--individual responsibility. (We don’t pay for healthcare needs brought on by personal habits.)
In ending, he states that “there is broad agreement on the problem.” Perhaps true. And “there is no agreement on solutions.” Definitely true. Any solution will require leadership and courage. That is, after we define what the problem is.
