Sunday, March 28, 2010

Health care reform – the road ahead

Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
Winston Churchill, 1942.

One way or another I'm gonna find ya
I'm gonna getcha getcha getcha getcha

In the original Senate version of the Health Care reform bill we find this clause …

Subtitle D: Improvements to Medicaid Services - (Sec. 2301) Requires Medicaid coverage of: (1) freestanding birth center services …

Yes, there are a lot of funny bits in this sausage. We don’t know the half of ‘em, but I do know my family will pay for them. Now that the bill done (for now) I can say that the wingnuts were right about some things; my team’s “$250,000 and above” slogan was nonsense. “One way or another” upper 30th percentile “tax-equivalents” [1] will go up.

I’m good with paying for this; I expected to pay for it when I campaigned for Barack Obama. Altruism aside, there are tangible personal benefits for my family:

What’s next? We’ve been stuck in the headlights for a generation, but now we’re moving. We might be charging towards the oncoming truck, but even that may be an improvement on standing still. At least with motion comes opportunity.

The question isn’t where we need to go. We’ve known that for at least thirty years. We’re going to the same place as everyone else on earth – good enough care for everyone and luxurious care for those with money. The question is how we get there.

Until now the American people have been completely unwilling to think about health care cost. It would have been nice if we could have cut costs before increasing access, it would have been nice if we’d come up with a reform plan that made it easier to cut costs, it would be nice if we weren’t charging towards the right fender of that oncoming truck. Nice – but not going to happen in a world where the GOP has gone mad.

Now, however, we’ll all be, at last, considering costs and value. It won’t be pretty, but if it were pretty it wouldn’t be real.

That’s progress.

See also:

Post-passage commentary

Older general discussions that are still relevant

The future: “pretty good care”, aka “good enough care” – where we’re going

[1] Federal “Taxes” rarely include anything so obvious as a rate increase. Tax equivalents include

  • actions that shift services burdens to the states – which either reduce state services or increase state or local taxes
  • unfunded federal state or local mandates of all varieties including regulatory or reporting burdens
  • means testing that remove tax breaks (the AMT is the mother of means testing)
  • elimination of tax dodging programs such as the Flex plan we enroll in (I’ll be glad to see that evil scam die)
  • user fees
  • service taxes (such as the 10% tanning tax – which, amusingly, is aimed squarely at the Tea Party demographic of less educated paleskins).


Paul said...

I’m pleased the BO got the ball rolling towards healthcare for all over there. Now all that needs to be achieved is understanding that healthcare for all can never mean healthcare for all because there is never enough money to go around. Then comes the hard task of deciding how and what to allocate the money to. Would you rather fund treatment for an infant or a pensioner? Pay for an operation or a course of drugs? Difficult decisions ahead...

JGF said...

Economists have a term for things that are unlimited goods. Alas, I don't remember it!

Not all health care is helpful, but you can get incremental benefits from an almost unlimited amount of it. That's especially true with luxury care -- better parking, nicer music, artwork on the walls...

Brits and Canucks are routinely shocked by how luxurious many American hospitals and facilities are. Nice stuff, necessary to compete, and I'm paying for it.

On the bright side, there's a lot of 80/20 Pareto optimization to do. Luxury care can pay for the innovations that basic care gets to use when the costs and profits are recovered.

Luxury care patients also get to try out the therapies that don't work first ...