Access vs Cost Controls in Health Care Reform

by Bruce Webb

There has been some discussion here and there about whether the HCR bills in place do enough for cost control. I think that this is the wrong question at the wrong time and points out a bigger issue in progressivism, that is what exactly is our project? Comment by me to this post by Ezra Siding with Cost Control under the fold.

This is not a cost control bill and should never have been allowed to become one. This bill is by name and intent a bill focused on access and affordability which go hand in hand. The demand that the bill even be budget neutral was bad enough that it also had to hit selected and arbitrary spending targets was from a progressive perspective a regrettable compromise.

You have 50 million people with only limited access to what is by all measures an expensive service. You decide that almost everyone should have equal access to that service. But decide that on net it can’t actually cost any more than before, that all moneys need to come from within societal medical spending. Thank God we didn’t take that approach when it came time to establishing public education and libraries, when Massachusetts introduced public higher education did they insist on a surtax on Harvard tuition to pay for it?

Of course cost control is important and in the medium term absolutely vital, but particularly the Senate has been a little too eager to trade away access and affordability to achieve short term cost savings apparently indifferent to the fact that every additional percentage of the non-elderly population NOT covered is another 2 million people or so priced out of insurance.

I start from the position of Social Democratic Utilitarianism, decide where social and economic justice lies and then strive for the greatest good for greatest number solution that you can achieve through democratic means. But at least start from the goal and concede only what you have to. I mean who exactly signed us up for the Pretty Darned Good Society? Or the Near the Frontier? or the Modified Deal?

We have a 2074 page bill that does lots of stuff including some measures that I think will produce more cost control than people think. But somebody needs to keep an eye on the prize which is to deliver what other developed countries treat as a right, that is universal health care. If that ticks up the percentage of GDP spent on health care we can start working on cost from the other side of the equation, after we get the access issue settled.

Of course it is both impossible and undesireable to simply divorce ends and means, there are a lot of things we would like to buy that simply are not affordable. For example I want an end to world hunger tomorrow, and I am sure there are little girls in public housing that desperately want a pony. Odds are neither of us are going to get our wish fulfilled immediately, or maybe ever. But that does not mean you don’t start from a goal.

And the opposition does this all the time. The modern Republican Party defines National Security as an absolute and is currently blasting any questioning of the cost of any particular component and still less any proposals that require that it be paid for to be nearly treasonous, even as they dismiss universal health coverage as some utopian dream never to be achieved. Yet when you put those two goals side by side universal health coverage is achievable in ways that universal national security is not and the stakes in terms of lives are much higher in the former case than the latter. Of course we want to prevent another 9/11, on the other hand in the eight years since about 15 people are reported to have died from lack of health insurance than died in that one-off event. EVERY YEAR. No we don’t have dramatic video footage of firemen rushing into or people jumping off burning buildings but those people are just as dead.

The Republican Party has performed a neat trick, one that Neo-Liberals and ‘Realists’ have fallen for completely. Divide spending into two categories: Spending we CAN’T afford. vs Spending we can’t NOT afford. And then stick all Great Society and New Deal programs in the first category, while placing all MIC (Military Industrial Complex) programs in the second. And then layer the first with ‘fiscal responsibility’ and ‘intergenerational equity’ and the latter with ‘patriotism’ and ‘keeping our grandchildren safe’ as if that kid was more exposed to a potential terrorist attack than illness and disease. I AM thinking of the children when I say they should have health care coverage and a quality education, yet those goals somehow get tossed on some utopian scrapheap.

The New Frontier and the Great Society were bold affirmations that we could do better, that we could reach for the Moon AND feed the children, yet somewhere along the way we fell hostage to the advice “Wouldn’t be prudent”. Well the hell with that.