An American plan to help the uninsured, restore Medicare’s fiscal soundness, and preserve medical excellence.
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There is more legislation on the way. Democratic leaders of three House committees and two Senate committees have pledged to have health-care bills ready for a vote by August. The misconceptions driving these legislative efforts could be dangerous to your health. One is that prevention will eliminate the cost of treating sickness. Prevention saves lives, but 80 percent of preventive measures do not save money. Most of the people who take cholesterol-lowering medications and other precautionary measures would not get sick anyway. Louise Russell, an economist at Rutgers University, concludes that “hundreds of studies have shown that prevention usually adds to medical costs.” (Health Affairs, March-April 2009.) The economics of prevention are so clear that the only people who claim it saves money are politicians.
Nancy-Ann De Parle, director of the White House Office of Health Reform, said on March 23 that “we have to get to a system of keeping people well, rather than treating the sickness.” That would make sense if all disease were behavior-related, but many cancers and other diseases are linked to genetics or unknown causes. De Parle’s pronouncement echoes how Sir Michael Rawlins, a British health official, explains his nation’s low cancer survival rates. The British National Health Service, he said, has to be fair to all patients, “not just the patients with macular degeneration or breast cancer or renal cancer. If we spend a lot of money on a few patients, we have less money to spend on everyone else. We are not trying to be unkind or cruel. We are trying to look after everybody.”
This approach is deadly for those with serious illness. In the U.S., about 5 percent (.pdf) of the populace needs 50 percent of treatment dollars. The drumbeat for shifting resources from treatments to prevention should worry any family dealing with M.S., Alzheimer’s, Parkinson’s, or cerebral palsy, or with a history of cancer.
By far, the most dangerous misconception in Washington is that the way to rein in health spending is by slowing the development and use of new technology. Imagine any industry or nation thriving on such a philosophy.
Dr. Emanuel criticizes Americans for being “enamoured with technology.” Dr. Blumenthal attributes fully two-thirds of the annual increases in health spending to medical innovation.
On that he is correct. A 2008 CBO study documented that at least half of annual health spending increases are due to new treatments and tests, not administrative costs, waste, or even the aging of the population. But the CBO report also reminded us that these innovations “permit the treatment of previously untreatable conditions.”
Walk into an electronics store and you will see an array of products that did not exist twenty years ago. The same is true in healthcare, another industry where growth is driven by innovation. Treatments for heart disease and strokes are as unlike care in the 1960s as the new flat screen televisions are unlike the black and white sets of five decades ago. If you had a heart attack in the 1980s and made it to the hospital alive, you still only had a 60 percent chance of surviving until the end of the year. Now your chance is over 90 percent. Your chance of surviving a stroke is more than twice as high as it was three decades ago.
Overall health spending could be reduced by 30 to 40 percent by settling for the standard of cure and symptom relief available to patients in 1960, but there is no demand for 1960s medicine at 1960s prices, say CBO researchers. Families dealing with incurable illnesses go to bed every night hoping the next day will bring a cure. The administration’s strategy of slowing new technology in order to restrain spending will make the wait for breakthroughs longer.
A Low Risk Alternative
It’s one thing to criticize. What’s needed is a low-risk way to help people who can’t afford insurance. The U.S. Census Bureau shows that of the 47 million people identified as “uninsured,” 14 million are already eligible for government programs such as Medicaid and SCHIP (for children) and simply need to sign up. Another 10 million have household incomes over $75,000. That leaves 23.7 million people who need help affording insurance, not 47 million.
Food debit cards help 27 million people buy food, similar to the number who need help buying health coverage. In all fifty states, debit card technology has transformed the federal food stamp program, which used to be notorious for fraud and abuse. (Only 2 percent (.pdf) of card users are found to be ineligible, according to the General Accounting Office.) Cards are loaded with a specific dollar amount monthly, depending on family size and income, and allow cardholders to shop anywhere. The same strategy could be adapted to provide purchasing power to families who need help buying high-deductible health coverage. It’s what all Americans used to buy (see chart 5), and it’s all that’s needed for families with moderate incomes, who can afford a routine doctor visit.
Debit cards are better than refundable tax credits for three reasons. Many people are uninsured only temporarily (about 22 percent) and not at tax time. Also, some people don’t file an income tax return. Finally, a refundable tax credit would remove even more people from an obligation to pay federal income tax at a time when half of Americans don’t pay it.
Providing sliding scale assistance, based on household income, to families to purchase this type of coverage would cost $20 to $25 billion a year. The cost estimate could vary for two reasons. First, only a fraction of people who are eligible for government programs actually apply (50 percent of those eligible for food debit cards). Second, U.S. Census data show that many of the uninsured are newcomers to the U.S. (some here illegally). The largest influx of immigrants in any seven years in American history occurred in the present decade. In this same decade, the lion’s share of the increase in the number of uninsured took place in the five Border States. In San Francisco, 61 percent of the uninsured are not U.S. citizens, according to public health officials there. The public has not yet decided whether newcomers should be covered.
A man of faith in a godless age is hitting Americans where it hurts.
Mr. and Mrs. American Spectator Reader, let P.J. O’Rourke talk sense to your kids.
In Britain, defending your property can get you life.
The debacle of this president’s administration is both a cause and a symptom of the decline of American values. Unless Congress impeaches him, that decline will go on unchecked. An eminent jurist surveys the damage and assesses the chances for the recovery of our culture.
It won’t take long for conservatives to scratch this presidential wannabe off their 2008 scorecard.
The American Christmas, like the songs that celebrate it, makes room for everybody under the rainbow. Is that why so many people seem to be hostile to it?
Was the President done in by the economy, or by the politics of the economy?
H/T to National Review Online