A Democrat Speaks Out on Health Reform
This is Jim Marshall (D-GA) writing at National Review Online:
The Problem:
The federal government’s current regulation of health care, encapsulated in fine print on merely 132,000 pages, is costly, clumsy, inefficient, and inequitable. Doing more of the same to achieve cost containment will be painful and disruptive to medical providers and the voting public, making serious cost containment highly unlikely. So a fair observer would conclude that the 2010 reform legislation will help millions of Americans in different ways, hurt millions of Americans in different ways, and generally lead to increased costs.
The Private Sector Answer:
High-deductible or catastrophic [plans] plus medical savings accounts the employee can tap for any purpose once the amount on deposit exceeds a specified level. These accounts should be portable and roll from year to year.
The Public Sector Answer:
In time …Medicare might introduce individual accounts owned and managed by participants, inheritable upon death and backed by catastrophic insurance. Medicaid might do something similar. Each would limit these programs to those who could competently manage their own medical affairs either directly or through a representative.
The Sine Qua Non:
Our third-party-payer dilemma was decades in the making. We mustn’t take that long to correct it. Without real health-care reform, we will continue to waste 10 percent or more of our national wealth and never find an appropriate balance between health care and other priorities. Unless we significantly reduce the role of third-party payers in health care, we will surely bury future generations of Americans in debt.
Amazing. We hear such nonsense from most of the Ds, it’s easy to forget that some of them are rational.
Marshall’s district is actually a republican district. He squeaked through his last election with a 1700 vote margin. Given it’s a poor (32K median income) very conservative district, it’s not surprising he would be espousing a conservative position on health care. I won’t mention the irony that a district like his complains about government spending but gets significantly more in federal benefits then they pay in taxes.
As for the merits of his proposal, it solves nothing. The typical Medicare recipient’s lifetime contributions only cover 40% of his or her lifetime cost to Medicare. If it’s put in a individual account you just have a more expensive system. The families with a parent that gets run over by a bus gets to inherit the account. The medical expenses of the rest who are almost certain to overspend the account will still be borne by the taxpayers.
The problem is there is no free lunch, you can talk free market all you want but unless you’re willing to severalty limit care or limit the revenue all parts of the health care system collects the problem will continue. You can talk about consumer choice till you’re blue in the face, but once you get that final illness that puts you in the grip of the most expensive high tech medicine conceivable for the last year or so of life, there is no choice, and that’s when the real costs add up. Want to cut medical care costs by over half, figure out the last year or so of life and eliminate care for that final set of illnesses.
Good thoughts from Rep Marshall. Hear. Hear.
Artk,
Have you learned nothing from your many visits to this site? Empowering patients not only works, it is the only thing that works. See my post at Kaiser today — http://www.kaiserhealthnews.org/Columns/2010/July/072610Goodman.aspx. Only when patients control the dollars do innovators truly find ways to reduce costs and raise quality.
On how to create private, funded accounts under Medicare, we have solved that problem, too. See our study here: http://www.ncpathinktank.org/pdfs/st315.pdf
John
If only this guy could convince his buddies to join his plan…
I disagree, Artk. The reason that the last year of life is so expensive is because we don’t pay the direct cost of our care. It’s a tragedy of the commons on a massive scale.
Consumer choice is all about weighing the costs and benefits, and that includes deciding whether or not open heart surgery at age 85 is worth it. It is a form of rationing care, but it’s done at a personal level. If consumers can afford expensive, end-of-life care, then by all means, they should receive it. But, the rest of us will actually have to budget for our care.
I don’t know if inheritable medical accounts would reduce medical costs, but I can believe they might reduce expenses for non-professional care as relatives take on more of the burden.
It’ll be interesting to see what happens to death rates and medical utilization after December 31, when the suicide exemption expires.
I am always surprised to see someone who actually knows something about health care cite plastic surgery and Lasik as viable examples. Both of these are completely, 100% elective decisions. Both parties in the deal, physician and patient are free to walk away at any time. There are none of the time and geographical limitations seen in most medicine. Patients can save up for them fairly easily as they are not generally inpatient procedures and require little input from other specialties, none for Lasik. They are usually bought by younger patients, more affluent and better informed. There is not as much information asymmetry. There is virtually none of the emotional context seen with many other major procedural decisions.
There are probably a small number of medical areas that can be made to work on a model like Lasik. For those, go ahead, but do not present them as real models for most of medicine.
I would like to see HSAs work in a model that has no real selection bias. A lot depends upon the level of the deductible. Again, there are two parties to the deal here. It should be fairly easy for physicians to respond by bundling procedures and/or tests to make sure they go well over the deductibles. HSAs also do not seem to offer much advantage for those with chronic disease. Readers should be aware of spending distributions among the population.
Steve