A Cheaper Health Reform Bill is a Worse Health Reform Bill
He's got the beet sugar
When you think about costs and health care reform, I think it’s useful to distinguish between cost per person and overall cost. If you want to say that controlling health care cost increases is important, which I think it is, you ought to be talking about cost per person. If health care costs go up because the population grows, that’s not a bad thing. And if you save money by simply having people go without health care, that’s not a good thing. The kind of cost controls you’re looking for are the kind that deliver care to people more efficiently, not the kind that just deprive people of health care.
All versions of health reform currently before congress achieve some of the good kind of cost controls. But it looks as if the Finance Committee’s quest to cut its $1.6 trillion health reform bill down to a $1 trillion health reform bill overwhelmingly involves the bad kind of cost controls:
Senate Budget Committee Chairman Kent Conrad (D-N.D.) said the Finance Committee had reduced the overall cost of its bill by cutting subsidy levels for uninsured people.
Now if you really think that “passing bills that involve round numbers” should be a top policy priority for the Senate, this is a great deal. And, conveniently, zero members of the United States Senate will be adversely impacted by these subsidy cuts. But that’s a substantial amount of human welfare being sacrificed for no real reason. To pay for more subsidies, what you would need is more taxes, and again some sound revenue ideas appear to be getting rejected for not-very-good reasons:
The Joint Committee on Taxation calculated that a 3-cent tax on each 12-ounce sugared soda would raise $51.6 billion over a decade. But opposition is not limited to the bottling industry. Major sources of sweeteners include Montana, which has a large sugar beet industry, and Iowa, which produces high-fructose corn syrup — the home states of Senators Baucus and Grassley.
Ezra Klein reminds us that the Senate also seems determined to leave $300 billion in revenue to be gained by curbing reductions for rich people on the table. Economically struggling Americans looking to pay for health care will pay the price for that decision.
24 Responses to “A Cheaper Health Reform Bill is a Worse Health Reform Bill”
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June 26th, 2009 at 1:04 pm
I don’t think the “$1 trillion” cost is magical b/c it’s a nice round number. I think it’s magical b/c that was the ten year cost that the Dems put in the budget outline, and they have to hit that target to use the budget reconciliation process so they can pass the bill w/ 51 senators. Maybe they should have included a bigger # in the original budget. I think they did not b/c they thought $1 trillion would be adequate. The CBO’s estimate surprised them after the budget outline was passed. But whatever # they chose for the budget outline, they’d have to stick to it now. Right?
June 26th, 2009 at 1:18 pm
And if you save money by simply having people go without health care, that’s not a good thing.
Yes it is – you’d be the first to admit that a lot of what we do is not really medically necessary.
How do you think other countries do so much for so little money – they pay their doctors, nurses, and techs substantially less and they provide less care.
Does a 92 you with dementia really need dialysis? No, she needs to go towards the light.
June 26th, 2009 at 1:18 pm
Holy crap that’s a lot of soda. No wonder health care costs so much.
June 26th, 2009 at 1:33 pm
Your photo captions have been getting better each week Matt. Keep it up! (still laughing about the socialist ambulance)
June 26th, 2009 at 2:01 pm
jmo: There’s a huge difference between reducing unneccesary treatments by reducing coverage of treatments and simply leaving more people uncovered entirely. Especially because the 92 year old with dementia is already on Medicare and so they’re probably not going to take her health care plan away, so lowering costs by lowering the number of patients covered will come from less medically justifiable cases.
If you cover everyone but don’t cover wasteful treatments, the costs are born in a just and efficient manner. But if you just refrain from covering people who can’t afford health care but aren’t poor enough for Medicaid but still provide wasteful treatments to those who have health care, then it’s inefficient and unjust.
June 26th, 2009 at 2:21 pm
If other nationalized countries provide such less care, why are we not dominating them in every health statistic? Why are we getting beat in any health category at all?
June 26th, 2009 at 2:31 pm
“why are we not dominating them in every health statistic?”
We are. If you look at the outlook for any given diagnosis for an American with insurance we are number 1. In cancer survival, trauma, HIV, heart disease, stroke, etc we are at the top. The only reason we lose on WHO studies is they ding us for lack of universal access. Our life expectancy numbers are lower due to lifestyle issues not directly attributable to the health care system.
For example, the Japanese don’t live so long due primarily to their superior healthcare system, they live longer due to a far superior diet, and perhapse some genetic advantage.
June 26th, 2009 at 3:10 pm
Our life expectancy numbers are lower due to lifestyle issues not directly attributable to the health care system.
That’s an assertion, not a fact, and it’s a stretch as an assertion. McKinsey’s study questions the “well, we eat cheeseburgers” argument, and it’s really just a dodge to use Japan as your example, instead of making the “lifestyle” comparison with Australia or Canada.
As I’ve mentioned before, focusing on ‘outlook for diagnosis’ rates is another sidestep — it’s really like saying that the US has the best termite extermination outcomes when your house get infested, while overlooking what might lead those houses to get infested in the first place.
June 26th, 2009 at 3:20 pm
pseudonymous in nc,
overlooking what might lead those houses to get infested in the first place.
Perhaps we have the best health care system and our poor life expectancy is due primarily to poor agricultural policies. If that’s the case it we should endeavor to change our agricultural policies rather than our health care system.
June 26th, 2009 at 3:35 pm
Re: “The only reason we lose on WHO studies is they ding us for lack of universal access.”
You make it sound like they are penalizing us because they don’t like our health care delivery system. The WHO data look at mortality/morbidity rates for the country as a whole, not just people with health insurance. So of course we get “dinged”, because more of our people die or live with untreated diseases.
Also, although other countries do provide a more-or-less basic amount of publicly-funded health care to all their citizens, many countries still allow individuals to buy supplemental coverage on the private market. None of the U.S. proposals currently under consideration would disallow that. It would be interesting to see data on insured Americans vs. individuals from the other countries who purchase supplemental insurance.
BTW, where did you get the information that insured Americans have better survival rates for everything compared to the rest of the world? I’m not necessarily disputing it, but I’m interested in seeing that data.
June 26th, 2009 at 3:42 pm
Julie,
“called the CONCORD study, Coleman’s team collected data on 1.9 million cancer patients in 31 countries. Using cancer registries from each country, the researchers compared the five-year survival rates for breast, colon, rectal and prostate cancer. ”
“There’s also a significant difference in cancer survival rates between the United States and Europe, with survival rates 10 percent and 34 percent higher in the United States for breast cancer and prostate cancer, respectively, the study found.”
June 26th, 2009 at 3:51 pm
Julie,
On thing though – this study just looks at cancer survival rates and doesn’t adjust for those who have insurance.
Ex:
Whites and blacks in the USA saw differences in cancer survival between 7 and 14% – favoring whites. Specifically, white women had a 14% higher survival for breast cancer than black women, and white men had a 7% higher survival for prostate cancer than black men. What are the reasons for these racial disparities? The researchers suggest that white and black people receive diagnoses in different stages of the disease, have unequal access to health care, and are different in complying with treatment.
One could imagine that if we limited the study to only those who have insurance, the vast majority of Americans, the gap between Europe and the US would rise.
So, it could be argued that the US system does give value for money and we should increase taxes to provide care for the remaining 12 million uninsured who aren’t already eligible for existing government programs, or who earn enough to buy it privately if community rating was mandated.
June 26th, 2009 at 3:56 pm
Perhaps we have the best health care system and our poor life expectancy is due primarily to poor agricultural policies.
“Perhaps.” “One could imagine.” “It could be argued.”
Or, to put it another way, you’re just pulling it out of your ass.
June 26th, 2009 at 4:06 pm
We spend about $2.6 trillion a year now on healthcare, so the ten year number could be $25-35 trillion easily. Why sweat $1.5 trillion, a number which is basically round-off error?
June 26th, 2009 at 4:09 pm
pseudonymous in nc,
And you’re not?
June 26th, 2009 at 4:10 pm
pseudonymous in nc,
I’ve listed some facts – you’re more than welcome to argue and present facts of your own.
I’m not saying we shouldn’t provide universal care, I take issue with the argument that our healthcare system doesn’t provide value for money.
June 26th, 2009 at 5:03 pm
This may be overly facile, but wouldn’t a better way of achieving the soda tax goals be to stop subsidizing corn and sugar beet production?
June 26th, 2009 at 5:33 pm
Hi JMO–I couldn’t get access to that Lancet CONCORD study on cancer survival rates (subscription only), but I think I found the same article you quoted. It said we had the best survival rates for breast and prostate cancer, Japan had the best survival rates for colon and rectal cancer in men, and France had the best survival rates for colon/rectal cancer in women.
France has a system in which everyone is covered for chronic illnesses such as cancer and can also buy supplemental insurance or get it through employers. I think a similar system could work here, although with more limits. (ie, no visiting the hospital for minor illness, etc.)
June 26th, 2009 at 6:17 pm
jmo#7 says “We are. If you look at the outlook for any given diagnosis for an American with insurance we are number 1. In cancer survival, trauma, HIV, heart disease, stroke, etc we are at the top. The only reason we lose on WHO studies is they ding us for lack of universal access. Our life expectancy numbers are lower due to lifestyle issues not directly attributable to the health care system”
Look a little mor edeeply into those numbers and you will discover that those rates are skewed because of our countries ridiculous attempts to diagnose cancers “early”. therefore, every 90 year old man who gets a urethroscope in the USA becomes a cancer survivor (as he dies from heart disease or some other old age problem) whereas in europe the money isn’t wasted to test him, since he will still die of heart disease etc… Thus US with better “survival rates” that mean nothing. These are the wastes of money, and they exist everywhere, wasteful procedures(think skin biopsies, premalignant cervical warts,and especially prostate cancer in men) that are “cures” that truly only waste money as no one was dying from them, and need not have been diagnosed (ie. skin cancer doesn’t need a biopsy just an excision).
A sfor the costs remember what all of us know in the medical field. the cheapest healthcare patient is the one we let die. It is what we choose to spend our money on and what results we get from it that matters ONLY!
June 26th, 2009 at 6:23 pm
again julie above. the prostate cancer survival numbers are a statistical joke. And I suspect our unrelenting yearly mammograms with removal of every bit of tissue labelled as unusual or non specified tissue adds to breast cancer survival rates as well. it is becasue we overdiagnose, and also diagnose in people who will die of something else long before these diseases get to them. other country’s are smart enough mnot to waste resources on that, thus their numbers look bad, yet the same percapita percentage of men overall die from prostate cancer there as in the US because we diagnose so many more cases needlessly.
June 26th, 2009 at 7:01 pm
you’re more than welcome to argue and present facts of your own.
Already done it. And I’m not inclined to “argue” with people who pull rationales out of their asses. It could be argued that healthcare in the US costs what it does because of magic purple unicorns, too.
I’m not saying we shouldn’t provide universal care, I take issue with the argument that our healthcare system doesn’t provide value for money.
Again, I’ll quote Brad DeLong: “we give up $1 trillion dollars in real resources a year relative to other countries, and we get… what?” McKinsey is a little more generous in assessing excess expenditure:
If you can take issue with that, and say that the improved survival rates for certain cancers or other conditions are worth the money, whether in absolute terms or per-capita expenditure or proportion of GDP), then you’re all set.
June 27th, 2009 at 7:11 am
Re: There’s also a significant difference in cancer survival rates between the United States and Europe, with survival rates 10 percent and 34 percent higher in the United States for breast cancer and prostate cancer, respectively, the study found.”
What is a “cancer survival rate”? I’ve asked this question before. Is “survival” a synonym for “cure”? So that people with cancer who “survive” are cancer free and die years later of something else entirely? For some reason rightwingers in these arguments never use the word “cure”. That’s leads me to think these “survival” rates are capturing nothing more than either earlier diagnosis in the US, or the prologation of life at the very end in the US. Neither of which is much of an argument for the US healthcare system or its outrageous cost.
June 27th, 2009 at 12:22 pm
Is “survival” a synonym for “cure”?
Huh? They don’t “cure” cancer. They treat it and it goes into remission – you do know there is no cure for cancer, right?
June 29th, 2009 at 6:07 pm
Hi Alan–Yes, I agree with you regarding the overdiagnosis of prostate cancer. I mainly quoted that study in order to point out that the U.S. is not on top for every cancer statistic, as jmo’s earlier posts seemed to imply.
I don’t really think cancer survival is the best way to compare us with other countries, anyway. Most people diagnosed with cancer can (eventually) get on disability, and thus on Medicaid. So even uninsured people can usually get treated for cancer, even here.
I think comparing care for eventually disabling, but rarely fatal diseases like rheumatoid arthritis would be more informative.