first, you should know that the debate is not about whether or not heath care reforms are needed - everyone agrees that costs are astronomical and access is too limited. amidst all of the rhetoric, i believe the focus on those goals has been lost - we need to find a way to lower health care costs and provide increased access, but i do not believe a national health care system will accomplish either of those goals.
the financial argument that i've heard for a national health care plan is that the government, by being able to operate at a loss, will be able to provide coverage below the market value of other insurance plans and force insurance companies to operate more effeciently to lower their own costs. this argument rests on three extremely misguided assumptions.
- it assumes that the government can be efficient. to see an example of the government's inability to operate a health care program efficiently, we need look no further than medicare. when looking at the total cost of medicare, a whooping 10% of the bill goes directly to fraudulent activities - i don't mean old ladies getting extra massages, but organized criminal operations that are taking advantage of the government's inability to efficiently operate medicare. 10%. if we're trying to lower government costs, i'd say let's start there.
- it assumes that other areas of the economy can afford to pay for a program that operates at a loss OR the country can simply incur more debt without any consequences. when the government operates a program at a loss, it either has to bring in additional income from other sources (i.e. raise taxes on non-union so-called "cadilac plans") or it has to incur more debt. in terms of the debt, it took 43 presidents to incur $5 trillion of national debt, which is a staggering number already - between the stimulus bill earlier this year, health care, etc. this administration has plans to double the national debt in 5 years and triple it in 10 years. $15 trillion dollars in debt. that is something that me, my children and my grandchildren will have to be worried about paying off for....ever.
- it assumes that doctors and health care providers will simply accept lower rates for the same quality of service. again, i will refer to the medicare example. as i understand it, when a patient uses medicare to cover a medical expense, the doctor in turn submits the claim to medicare for reimbursement. unfortunately for the doctor, medicare does not reimburse at the actual cost to the doctor, and so the doctor has to take a loss. let's say an MRI costs $1000, but medicare only reimburses $500 - the doctor loses $500. but because the doctor runs a business, he has to find that $500 elsewhere, either by raising prices for non-medicare patients or by cutting costs in another area of operation, like research and development.
all of this is not to say the government cannot help - it can. allow companies to buy insurance across state lines, thereby increasing the level of competition and lowering costs. allow small businesses to pool their resources to negotiate for better rates. enact reasonable tort liability reform so doctors don't have to charge consumers for insurance against frivilous law suits. reduce fraud in medicare. those are small steps that would make a big difference and help us reach our ultimate goals - lower costs and increased access.
