I haven’t posted on the reform process not out a lack of interest but because every time I pick up the virtual pen I despair. I’ve been trying to decide if passing this bill is better than a continuation of the status quo, and the more I ponder the less sure I am.

But it’s time.
After months of negotiation, compromise, and horse-trading, we’re getting close to a health reform bill that will come to a vote – probably in the next couple or three weeks. There’s much work to be done to get to the magic sixty Senate votes, but it looks like no compromise, concession, or giveaway is too big to stand in the way of this must-pass (for the Democrats) legislation.
Yet after all this, we’re going to end up with a bill that won’t work – it will not appreciably reduce health care costs today, tomorrow, ever.
Sure, we’ll end up with lots more Americans covered, better/smarter regulation of insurers, and maybe even lower Medicare costs. But ten years from now, the system will be pretty much the same – a fee-for-service based health system with costs increasing well above inflation.
Why, you say? Aren’t there cost controls in the bill? Pilot programs that promise to reduce cost inflation by rationalizing the care delivered to patients?
No, there aren’t. What we have is a mishmash of ideas that have long been on the table, demonstrated to work, and completely without traction. Not to mention the huge costs not addressed in the current bill – like the current quarter-billion dollar deficit in the Medicare physician reimbursement program, a deficit that will have to be added to the total cost of any reform initiative that changes how docs are compensated under Medicare.
Fortunately for Senator Reid, no one is asking what he plans to do about physician compensation, as the Senate bill assumes the 20.5% cut in physician reimbursement goes into effect on January 1, 2010. Does anyone believe that will actually happen?
But that’s just one of the many failings of the current bill.
– We have insurance reform with a mandate so weak it will not force anyone to buy coverage they don’t really really want.
– We have pharma still enjoying margins the envy of every other stakeholder in the ‘system’ and a government prohibited from negotiating with pharma for drugs bought with Medicare dollars.
– We have a “fix” that relies on private insurers to control costs, despite overwhelming evidence of the industry’s complete inability to have even the slightest impact on inflation.
– We have tough cost controls and cost reductions that will likely reduce Medicare’s costs over time – but no way for private insurers to stop providers from shifting those costs to them.
Other analysts have complimented Reid et al for trying everything, for not leaving any cost control mechanism, trick, or option out of the bill. That’s precisely the problem – the bill’s ‘experiments’ and pilots are way too little far too late.
Folks, health care costs are increasing a helluva lot faster than inflation. Our economy is increasingly hobbled by legacy and current health care costs, not to mention future liabilities. Governments are going to have to raise taxes – a lot – to deal with retiree health care costs. By the time these pilots and experiments are even ready for dissection in the pages of Health Affairs, (forget broad-based implementation) we’re going to be spending well north of $3 trillion a year on health care.
I’m disgusted by the political grandstanding of people like Joe Lieberman, whose incredibly self-important preening is just the most repulsive example of elected officials using this crisis to show us all how principled and irreplaceable they are. Mitch McConnell’s Medicare advocacy is so blatantly hypocritical it would be laughable if it weren’t so cynical. How he can scream about not cutting Medicare while protesting its expansion to the 55-64 year old cohort is a testament to his complete lack of self-awareness. Meanwhile the Democrats are so eager to expand coverage to as many as possible, they are completely ignoring the future cost of that expansion. The campaign contributions rolling in to Reid and Dodd and other players couldn’t possibly be influencing their legislation…they just don’t think it makes sense to put strong cost controls into health reform.
The public plan advocates have yet to make a compelling case for their statements that it will control cost – unless Congress requires all providers to participate at or close to Medicare rates, the public option will have zero impact on health care costs. Yet they’re spending untold hours and mountains of political capital trying to include some version of a public option in the reform bill.
Which leads back to the opening question – is the current health reform bill better than the status quo?
Yes, ever so slightly.