I’ve been trying to understand what’s being proposed in the upcoming health-care reform bill, and, let me tell you, it’s not been easy. There is so much emotion invested into the idea of this bill, both pro and con, that it’s hard to put all the claims and counterclaims together and get an idea of what it is and isn’t supposed to be — I’m not even talking about what it actually will and won’t be. Since the bills aren’t even finalized yet, nobody knows that yet. Unfortunately, there is little chance that the bills will finalize in time that people can really have a wide-spread public debate about the actual plans on their merits.
But I’ve been trying to understand how we’re supposed to provide health coverage for millions of currently un-covered people and, simultaneously, spend less money. On its face, this seems problematic — providing coverage for lots more people at less cost than we’re currently spending.
Now, as I listen to the proponents of the plan, I hear these claims and that these will be paid for by cost savings. And I hear claims that the people showing up opposing the plans are bought and paid for by the insurance and pharmaceutical companies. Putting it all together, it sounds as if the idea is that insurance and pharmaceutical companies are making massive profits and causing massive inefficiencies for health care providers, and that the proposed bills will reduce those profits and eliminate those inefficiencies by amounts that will allow for covering millions of new people for less expenditure than is currently being spent. Another part of the savings seems to be by removing people from Emergency Room care for non-emergent situations.
I’m not, at this point, interested in determining whether there is evidence to back up or refute these ideas. Right now, I want to understand, in basic terms, how the plan is supposed to be able to do what it claims it will be able to do.
On the obverse, I’m seeing a lot of misunderstanding (some of it quite willful, but much of it not) about where some of the claims of opponents are coming from, and will offer these pieces to help bring some understanding to the shrillness and shouting:
1. The “death panel” idea is not based in the “end of life” provisions of the bill. Not entirely, anyhow. It is based as much in the idea that most of an individuals health-care spending takes place during their final illness — “most” as in 70-80% of their life-time spending, and that chronic disabling illnesses and conditions consume a huge amount of total health-care spending. Thus, significantly reducing health-care costs is going to include looking at ways of reducing the expense of final and chronic disabling illnesses and conditions. Reducing expenses means that things that are currently being paid for are going to no longer be paid for, and there needs to be some kind of mechanism for how those decisions are going to be made. Whether this happens in this bill, or some future one, this is seen as a danger of government-controlled health coverage, and exploring ideas like this can be found in the writing of close associates of members of the government.
2. This bill explicitly allows people to continue with whatever health coverage they have if they want. However, the reasoning of those who say that this bill will take away the option of keeping your current coverage does make some sense: If there is a low-cost government option for health coverage available, employers who are trying to reduce their operating expenses are going to begin pushing their employees toward these options, which will result in people not having options other than the government option, and this problem will be exacerbated by taxing employer-provided health coverage, which has been mentioned as an option for how to pay for the reform plan.
There is generally, among more conservative folks, a tendency to trust the marketplace and competition (not exactly the same thing as trusting large corporations) as reliable ways to improve efficiency than government involvement. There is generally, among more liberal folks, a tendency to see government as “us,” and to trust government programs more than large corporations. These tendencies are colliding a lot in the conflict over this plan, and, without identifying these tendencies, and trying to address the concerns of each side, it will only get worse. Demonizing the other side, and accusing them of lying, will also make the problem worse.
And I’m not seeing the problem not getting worse. The increase of information flow thanks to the internet has tended to lead to people hooking up with people who share their views and assumptions, which has increased the tendency to see those who disagree as stupid, dishonest and/or evil. This debate is just the most recent example, and the frustration and fear about it is pushing things to a more desperate place, with violence breaking out. Dismissing and minimizing the concerns of those who disagree, and demonizing them for disagreeing, is a greater problem than anything this reform will or won’t avoid or create.