Earlier this morning President Obama came out to speak on health care reform so I thought it a proper topic for a posting today. I think it goes without saying that everyone agrees the current system is a mess and needs changes. We are spending billions, if not trillions, of dollars on health care and yet we still have millions of Americans without coverage and millions more with coverage that doesn’t seem to be working.
Having said that, I am a little disturbed by some of the rhetoric from the left, which seems to suggest that if you don’t support the current proposal from the President that you are somehow opposed to solving the problem. I am also bothered by the idea that we need to rush to pass the current proposal as soon as possible.
Further complicating the process is the fact that we have disinformation coming from both the left and the right. It almost requires as much effort to figure out what facts are true and what facts are false as it does to figure out what the best solution to the problem is. With this in mind I would like to start a discussion about the various issues connected with HCR and to see if we can have a reasoned debate on the topic.
Let’s start with the idea that we have to support the current proposal from the Obama administration or we are opposed to reform. I’ve heard this claim from various Congressional Democrats and find it not only silly but a bit insulting. I do want to reform health care but I’m not convinced the current proposal is a good idea.
To begin with we have the fact that according to the Congressional Budget Office the proposal would actually increase, not decrease the total cost of health care. If we are already dealing with the dual problems of runaway health care costs and huge budget deficits, I’m not sure that passing a proposal to increase the size of both is a good step to take.
In addition, I have a real problem with needing to rush to pass the legislation as soon as we can. Whenever Congress passes major legislation we are talking about bills that are hundreds, even thousands of pages long. We are talking about spending huge amounts of money which we arguably do not have and we are talking about programs that impact millions of people.
I was also reluctant to see the stimulus bills passed so quickly but at least there we had some argument that if we did not move quickly the damage to the economy would be worse than not moving. Here we do have some time to sit down and really look at the proposals and decide which program is the best.
One idea that I think is worth considering is that we move to solve the problem of the truly uninsured first before we move to establish a full blown program. While the numbers vary from place to place, even the most liberal estimates do not put it over 40 million people who are currently without coverage.
As best as I can tell from various sources, the uninsured are divided into five roughly equal groups consisting of 1) young people who choose not to have coverage for various reasons, 2) those who can afford insurance but choose not to purchase it (often this is actually people in fairly high income brackets), 3) immigrants, 4) the temporarily uninsured (for example those who have just started a job) and 5) pretty much everyone not included in the first four groups.
Of course nobody knows for sure exactly how these numbers break down but it does seem to be true that at least some of those in the uninsured group are there by choice and they don’t necessarily need to be covered. This does not mean that we do not have a large group of people who need help but it does mean the group may be smaller than we currently think.
So perhaps one step to take would be to determine exactly how many people are truly in need of coverage and how many are making the choice not to have coverage. If I am a young healthy person who doesn’t feel the need to be covered or if I am wealthy enough to cover my own costs, perhaps I should have that choice. I’m a little less sure on the first group than the second, at least in terms of catastrophic coverage.
Once we determine who is truly uncovered, perhaps the next step would be to get these people covered in some way, perhaps through subsidies to allow them to purchase insurance coverage on their own. We could also look to pass other reforms, such as tort reform, to help reduce medical costs.
Taking these steps would allow us to get coverage to those who need it while also allowing us to take time in determining what the best long term solution would be. Certainly we have many examples around the world to choose from and they seem to have both good and bad elements.
In addition we need to look at the validity of the claims on both sides of the debate, whether it is the validity of the claims on overhead costs or the accuracy of the allegations about the problems with the Canadian or European systems.
Obviously I am not suggesting that I have all of the solutions, if I did I’d probably be sitting in an office in Washington instead of writing on a blog. But I do think that this debate is something that we need to take our time with. In the coming days and weeks I’d like to try and cover the various issues I’ve outlined here.