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August 27 -  September 2, 2009

• See Letters page

• Jim Hightower

Want health care reform? Control costs first
by Paul Danish

In three words, here’s how to get health care reform passed: Control costs first. Don’t even think about a public option or universal coverage until that much has been done.

The problem with the American health care system is not that 45 million people are uninsured. The problem is that health care is currently sucking up more than 17 percent of GDP, or about $2.5 trillion a year out of a $14 trillion-plus economy. And the proportion of national wealth spent on health care is growing at a rate of more than 6 percent a year — meaning we’ll be spending about $5 trillion a year by 2020.

This sort of spending isn’t sustainable, a point President Obama has repeatedly made in arguing for health care reform. He’s got that much right; it’s his most compelling argument, in fact.

But health care reform is in trouble both with the American people and in Congress — and the principal reason isn’t misdirected fears about “death panels,” but well-founded fears about runaway costs and the government’s inability to control them. Obama’s reform proposals, among other things, call for extending coverage to 45 million more people than are currently insured and for banning insurers from denying coverage for pre-existing conditions. You can make a plausible case for doing so in terms of social justice, but to claim that these can be done without a huge increase in spending and taxes and/or major cuts in benefits — as Obama has done — doesn’t pass the smirk test.

Health care reform is in trouble for a second reason, as well. Health care reform is largely a product of the Democratic Party — and the party has spent the first seven months of Obama’s presidency raising doubts in the public’s mind about its ability to handle money wisely and mange big government programs competently. Granted, much of the rap is unfair. But, as John Kennedy once remarked, life is unfair. Between the stimulus bill, the bank and auto company bailouts, the Cash for Clunkers problems, and a more than 300 percent jump in the federal deficit, rightly or wrongly, the Obama administration and the Democratic Congress are widely perceived as financially reckless — i.e., not the best folks to turn to for re-inventing health care.

So what’s to be done? Hit the re-set button (to coin a phrase). There are scads of proposals floating around for cutting health care costs. Mash ’em up into a bill. See what works and what doesn’t, and keep doing what works and stop doing what doesn’t.

For example: Try computerizing everyone’s medical records (that one’s actually in the current bill). Computers have cut costs and increased productivity throughout the economy. Why should health care be any different?

Or try Whole Foods co-founder John Mackey’s idea of removing legal barriers to employers offering employees high-deductible ($2,500 to $5,000) insurance policies, together with an annual cash benefit paid into an employee’s personal health care savings account that can be used to cover expenses incurred before the deductible limit is reached. That idea saved Whole Foods a bundle and has given young employees affordable health care coverage more tailored to their needs.

Or try tort reform, which would give doctors some relief from crushing burden of malpractice insurance (which can amount to 35 percent or more of a practitioner’s gross revenues) and from the need to practice defensive medicine, i.e. ordering expensive tests whose main purpose is to protect against lawsuits.

Or ban the practice of keeping drugs that could safely be sold over the counter on prescription for the sole reason of protecting a drug company’s extortive markups.

Or, instead of jumping into bed with big drug companies as Obama has done, deal with those worthies the way JFK dealt with the major American steel companies when they brazenly conspired to raise prices in April 1962. He ordered the Justice Department, then headed by his brother Robert Kennedy, to begin a sweeping anti-trust investigation of the bastards. Two days later the price increases were rolled back. Eric Holder should stop obsessing about the CIA slapping around terrorists and start looking into health care pricing policies generally — everything from drug prices to the cost of insurance to doctor and hospital fees. It’s a good bet he’d find a target-rich environment.

There are scores of other possibilities.

Politically, health care reform is a lot like immigration reform. When the latter was proposed by Bush, there was a grassroots uprising against it that said, in so many words: “Control the border first. After you prove you can do that, then we will talk about amnesty and pathways to citizenship for illegal aliens. But not before.”

It’s the same with health care. The public is saying, “Prove that you can control costs, even roll them back, and then we’ll talk about universal coverage and national health insurance. But not until then.”

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