Originally Published: August 3, 2009 10:11 p.m.
The current debate about health care is nothing if not complicated, and no informed person who has looked at our system would conclude that it does not need reforms to control costs.
For those who say, "the system is fine, leave it alone," we can say two things for sure. One is that they are either wealthy or have good health insurance, or two, they have not looked at or don't care about what is likely to happen to their taxes down the road or the burdens their children will face.
What's been bothering me is the current rhetoric we hear from the Obama administration about the need to reform the system, pay for current programs and save enough money so we can include most or all of the 45 million people who have no health insurance now.
And we heard this week that an additional 14,000 people a day are now falling into this category. Doing nothing is not an option. They are right about that. But, the question is, is doing what Obama plans enough to solve the long-term growth in current health care costs and assume new costs for the large and growing number of uninsured?
For example, will there be enough savings from steps like requiring all providers to use electronic medical records, or creating a Mayo Clinic model of care with a team approach, or emphasizing preventative care, etc. to bring the projected growth of current programs down fast enough so we can afford to add millions of new patients to a public plan with concomitant increases in public costs?
Looked at another way and not even considering the addition of the uninsured to a new public plan, can we afford the projected costs of Medicaid and Medicare even if the we implement suggested reforms? Mr. Obama does not present his plan this way. He presents it as a package deal, with the additional costs of the uninsured built in. Let's just say, for argument's sake, that we can realize projected savings, add the uninsured and maintain the growth in costs roughly as they are now, with no overall reduction. What does that mean for future budgets and our taxes?
I looked to the Concord Coalition for some basic numbers to outline better the magnitude of these costs. These numbers are tedious, but unfortunately necessary to have any grasp of the issue. We are currently spending $600 billion a year for Medicaid and Medicare. Medicare has 45 million enrollees and Medicaid has 60 million. At the same time, we are spending a total of $2.2 trillion for all health care, or about 16 percent of GDP. By 2018, at current growth rates, we'll spend $4.4 trillion for health care, or about 20 percent of GDP. The share of national health care expenditures financed by the public sector is now 46 percent and will climb to 52 percent by 2018. That's interesting, because most people probably do not know how "nationalized" our current system is now.
I strongly suspect that the bean counters (that's not a pejorative term because I used to be one) have had an effect on President Obama's thinking because he is back-peddling on a campaign promise and now considering taxes on health care benefits. His own health care economists must have analyzed the increased costs of his proposals and concluded they must find new revenue sources. In other words, the government cannot pay for these initiatives solely with proposed savings and ending the tax break on the wealthy. If he's willing to admit that now, at this stage of the debate, chances are the new costs must be huge. And if that's true, then how will he reconcile his commitment to grow the ailing economy while imposing new taxes on businesses for his health care program?
From this information a reader probably would conclude that I am against reforming the health care system or covering the uninsured in a new public program. That's not necessarily true. Personally, I cannot imagine what it must be like for a family to have no health insurance and face certain financial ruin if any member gets really sick. How do people dig themselves out of that hole?
However, everyone would appreciate a fair and open debate about how expensive these new programs will be, how we are going to pay for them and what trade-offs we must make to pay for them. If these healthcare changes will consume one-third of the federal budget, or more, will we face more taxes to continue paying for the other two-thirds as well, or are we going to cut federal programs accordingly to keep taxes at the current level? And who is to say that the current level of taxes is fair or sustainable? Will political bickering rule the day, or will we approach this debate with facts and informed choices?
Tom Bromley has lived in Prescott for eight years, after retiring from New York state government as a health care administrator.