Healthcare Reform - The Cost Control Mirage

Obama is telling people what they want to hear about health care, not what they need to know.

March 15, 2010

"What we need from the next president is somebody who will not just tell you what they think you want to hear but will tell you what you need to hear."—Barack Obama, Feb. 27, 2008

One job of presidents is to educate Americans about crucial national problems. On health care, Barack Obama has failed.

Almost everything you think you know about health care is probably wrong or, at least, half wrong. Great simplicities and distortions have been peddled in the name of achieving "universal health coverage." The miseducation has worsened as the debate approaches its climax.There's a parallel here: housing.

Most Americans favor homeownership, but uncritical pro-homeownership policies (lax lending standards, puny down payments, hefty housing subsidies) helped cause the financial crisis. The same thing is happening with health care.

The appeal of universal insurance—who, by the way, wants to be uninsured?—justifies half-truths and dubious policies. That the process is repeating itself suggests that our political leaders don't learn even from proximate calamities.How often, for example, have you heard the emergency-room argument? The uninsured, it's said, use emergency rooms for primary care. That's expensive and ineffective. Once they're insured, they'll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument.

Unfortunately, it's untrue.A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was "more convenient" to go to the emergency room or they couldn't "get [a doctor's] appointment as soon as needed." If universal coverage makes appointments harder to get, emergency-room use may increase.

You probably think that insuring the uninsured will dramatically improve the nation's health. The uninsured don't get care or don't get it soon enough. With insurance, they won't be shortchanged; they'll be healthier. Simple.Think again. I've written before that expanding health insurance would result, at best, in modest health gains. Studies of insurance's effects on health are hard to perform. Some find benefits; others don't. Medicare's introduction in 1966 produced no reduction in mortality; some studies of extensions of Medicaid for children didn't find gains. In the Atlantic recently, economics writer Megan McArdle examined the literature and emerged skeptical. Claims that the uninsured suffer tens of thousands of premature deaths are "open to question."

Conceivably, the "lack of health insurance has no more impact on your health than lack of flood insurance," she writes.How could this be? No one knows, but possible explanations include: (a) many uninsured are fairly healthy—about two-fifths are age 18 to 34; (b) some are too sick to be helped or have problems rooted in personal behaviors—smoking, diet, drinking or drug abuse; and (c) the uninsured already receive 50 to 70 percent of the care of the insured from hospitals, clinics and doctors, estimates the Congressional Budget Office.Though it seems compelling, covering the uninsured is not the health-care system's major problem. The big problem is uncontrolled spending, which prices people out of the market and burdens government budgets. Obama claims his proposal checks spending. Just the opposite. When people get insurance, they use more health services. Spending rises. By the government's latest forecast, health spending goes from 17 percent of the economy in 2009 to 19 percent in 2019. Health "reform" would probably increase that.Unless we change the fee-for-service system, costs will remain hard to control because providers are paid more for doing more. Obama might have attempted that by proposing health-care vouchers (limited amounts to be spent on insurance), which would force a restructuring of delivery systems to compete on quality and cost. Doctors, hospitals and drug companies would have to reorganize care. Obama refrained from that fight and instead cast insurance companies as the villains.

He's telling people what they want to hear, not what they need to know. Whatever their sins, insurers are mainly intermediaries; they pass along the costs of the delivery system. In 2009, the largest 14 insurers had profits of roughly $9 billion; that approached 0.4 percent of total health spending of $2.472 trillion. This hardly explains high health costs. What people need to know is that Obama's plan evades health care's major problems and would worsen the budget outlook. It's a big new spending program when government hasn't paid for the spending programs it already has."If not now, when? If not us, who?" Obama asks. The answer is: It's not now, and it's not "us." Pass or not, Obama's proposal is the illusion of "reform," not the real thing.

Author: Robert Samuelson
Found in Newsweek
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Kyle

One day when I was a freshman in high school, I saw a kid named Kyle walking home from school. He looked like he was carrying all his books and I thought to myself, he must really be a nerd carrying all his books home on a Friday. I walked on.


And then out of nowhere I saw a bunch of kids running toward him. They ran at him and knocked him down. His books went flying and his glasses landed in the grass nearby. As he looked up, I saw this terrible sadness in his eyes. My heart went out to him. As I jogged over, he was crawling in the grass looking for his glasses. There was a tear in his eye. As I handed him his glasses I said, “Those guys are jerks. They should get a life.” He looked at me and smiled and said, “Hey, thanks.”

It was one of those smiles that showed real gratitude. I helped him gather his books and asked him where he lived. As it turned out, he lived near me, but had gone to a private school before this year.

We walked home together. I helped him with his books, and he turned out to be a pretty cool kid. I asked him if he wanted to play football with me and some friends on Saturday. He said yes, and we hung out all weekend together. The more I got to know Kyle, the more I liked him, and my friends felt the same way.

Over the next four years, Kyle and I became best friends. When we were seniors, he decided to go to college at Georgetown. I chose Duke. I knew in my heart we’d always be friends. The miles between us would never be a problem. He wanted to become a doctor. I was going for a business degree on a football scholarship.

Kyle was the valedictorian of our class. Of course, I always teased him about being a nerd.

Graduation day came and he had to make a speech to the class. As the time for the speech drew near, I could see he was a little nervous so I went over and smacked him on the back and said, “You’ll be great, big guy!” He looked at me with that wonderful smile and said, “Thanks!” He then cleared his throat and began:

“Graduation is a wonderful time, because it’s a time when you have the opportunity to thank those who have helped you. Your parents, your teachers, your siblings, maybe a coach… but mostly your friends.

I am here to share with all of you that being a friend is the best present you can give anyone. I’d like to tell you a story.”

I looked on in disbelief as he told the story of the first day we met. He had planned to kill himself that weekend. He had cleaned all of the books out of his locker so his mom wouldn’t have to do it. As he spoke, he looked right at me and said, “Thankfully, I was saved. A person I didn’t even know, who is now my best friend, saved me from doing the ‘unspeakable’.”

I heard a gasp go through the crowd as this handsome, popular young man told us all about his weakest moment. His mom and dad looked over at me with a smile I’ll never forget.

Not until that moment did I realize the depth of what had happened. I realized for the first time in my life that we can never underestimate the power of kindness. One small gesture had changed a life forever.

Author Unknown