The Health Care Blog: Health Care Reform Lite

By J.D. KLEINKE

Under the plan that looks most likely to pass after some classic Capitol Hill 3 a.m. horse-trading - this time between the grumpy far left and poll-sitting centrists on both sides of the aisle - health care “reform” will involve little of substance beyond (1) the long overdue jamming of 46 million people currently outside the system into that system, and (2) an equally long overdue prohibition against health insurers kicking them back out. For the middle-class taxpaying swing voter in denial of what could happen in 90 horrifically unlucky days at their job and within their bone marrow, i.e., the average voter with coverage they might not be able to afford after simultaneously being fired and getting leukemia, #2 is worth the entire effort - and the reason any politician of calculation if not conscience should vote for the plan.

But at the end of the legislative process, and as with the bitterly debated Medicare Drug Benefit in 2004, all we’re doing is expanding exactly what we have today for most Americans, to include (almost) all Americans. We’ll spread the economic pain around the system fairly evenly, via mandates, taxes and fees that will show up in new equilibrium prices for insurance, drugs, and devices. And the economics of finally putting everyone into the system – instead of waiting until they are on death’s door, a.k.a., the door to the emergency room - will more than offset the upfront costs of getting them there.

Best of all, that last bit of accounting - which lifts what everyone knows to be the worst economic and emotional drag on the entire system - has not been accounted for in the current plan’s financial scoring. Such accounting involves too multivariate a set of equations, too many interdependent factors, too many unknowables in the cost and epidemiology of unmanaged disease – and so the CBO had no way to consider the most profound part of the entire initiative. Meaning: the systemic economic effects of including everyone in the system are gravy. Billions of dollars worth of gravy, if you believe any of the estimates of what the “safety net” costs all of us every year via the madness of hospital-to-insurer-to-employer-to-you-and-me cross-subsidy.
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