Editorial - Financing Health Care Reform - NYTimes.com
If health care reform falls apart again in Congress, the most likely cause will be failure to agree on how to subsidize coverage for tens of millions of uninsured Americans. The cost will almost certainly be at least $1 trillion over the next decade and perhaps much more, depending on how generous the reform might be.
... Our preference would be to extract savings from the bloated, inefficient health care system — but also to raise revenues from a wider pool, preferably from well-to-do Americans who could be taxed more for a badly needed reform that would benefit all Americans.
The first task is to find savings. Some respected analysts suggest that as much as 30 percent of all health care spending in this country — some $700 billion a year — may be wasted...
... Even with all the cuts people are considering, new fees or taxes will almost certainly be necessary....Let's dispense with the delusions about "waste". Gawande did a wonderful job with his paper published in a little known medical journal (The New Yorker) ...
Is the minimum right? The maximum? Something in between? What if biologics really worked -- but cost $100,000 a year per person treated? Forget all this blarney about "waste" and magical cures. There won't be any miracles. Electronic medical records won't save us.
… Brenda Sirovich, another Dartmouth researcher, published a study last year that provided an important clue. She and her team surveyed some eight hundred primary-care physicians from high-cost cities (such as Las Vegas and New York), low-cost cities (such as Sacramento and Boise), and others in between. The researchers asked the physicians specifically how they would handle a variety of patient cases. It turned out that differences in decision-making emerged in only some kinds of cases. In situations in which the right thing to do was well established—for example, whether to recommend a mammogram for a fifty-year-old woman (the answer is yes)—physicians in high- and low-cost cities made the same decisions. But, in cases in which the science was unclear, some physicians pursued the maximum possible amount of testing and procedures; some pursued the minimum…
So that leaves taxes. Meaning I'm paying for "your" health care. Or, should I lose my job, you're paying for my 3 kids and my wife and I (we'll take care of the dog). Believe me, we're expensive.
Since those lucky enough to be employed will be paying taxes to provide universal coverage, how much do we want to pay for? Do we want to pay for nice waiting rooms? For new CT scanners? For every effective treatment? For acupuncture and massage therapy? For herbal remedies?
I think we should guarantee good-enough care for every American -- and we need to accept that it will be damned Spartan. If I lose my job, I'd be very glad to have it for my family. If I keep my job, I'll be glad to pay for someone else to have it.
We need to start telling our politicians that we understand this, that we're grown-ups, that we don't believe in magic and ponies.
Because if we don't tell them we're cool with good-enough care, we won't get squat.