Liberal Values Defending Liberty and Enlightened Thought

While the Republican Party might have little meaningful to say on today’s issues, you have to concede they sure beat the Democrats when it comes to showing chutzpah. They are making a lot of noise over a report (pdf here) from a CMS actuary which means far less than they are claiming.

The first point of interest is that the Congressional Republicans have event turned to a CMS actuary. During the battle over George Bush’s Medicare Part D program, the Bush administration had threatened to fire a CMS actuary if he reported to Congress about the true cost of the program.

With this report the Republicans were able to obtain the answers they want due to the limitations placed upon the data requested. The report basically says that if you ignore 1) potential cost savings and 2) any increases in any forms of taxes, then health care reform will increase government expenses. You hardly needed an actuary to tell you that.

The report makes many of the same points I have made here in previous posts. Yes, as I have frequently written, health care reform will probably cost more than is estimated. Democrats are not without blame here. They are doing what all politicians do. The Democrats are underestimating the initial costs of their program, just as Republicans underestimated the cost of the Medicare D program and of the Iraq War. It is common for politicians to underestimate the costs of their programs. At least they are not threatening to fire those who present the data as the Bush administration did.

Among areas where the report is consistent with my previous predictions, they note that it does cost more to institute preventive care programs and that the cost savings of these are not clear. As I’ve previously argued, we should spend money on preventive because of its benefits to the country. Potential cost savings are an added benefit, but not the primary reason for spending money to have a healthier population with a longer life expectancy.

The report also is consistent with my objections to expanding Medicaid to provide coverage to the uninsured, noting that patients in Medicaid programs will have difficulties with access to care. Of course the solution to this problem is to spend more money to allow everyone to have private insurance or a public plan which provides benefits comparable to private insurance. It is doubtful that Republicans will agree to this added spending.

Health care reform is largely a matter of how much we are willing to pay and how much government action we are willing to accept to hold down costs. If this was purely a matter of cost, then by far the most cost effective way to deliver medical care would be a with a single payer system modeled on the Medicare program. Republicans try to obfuscate the benefits here by citing projections of future financial difficulties for Medicare if there are no changes. Of course any projections which do not allow for changes over time mean very little. What business would remain in business indefinitely if they never made changes? In addition, much of Medicare’s financial problems come from Republicans-sponsored measures in the Part D program which would be eliminated under health care reform legislation.

Republicans certainly will not accept a single payer plan regardless of how much money it would save. The added irony of their position is that they complain about the cost of health care reform while fighting most of the measures which would bring about the greatest cost savings. They oppose the public option (while a small number of economic conservatives have made a free market argument for the plan). Republicans also oppose plans to take future decisions on Medicare partially outside of the political process, and they even voluntary attack end of life counseling as the creation of “death panels.” Of course health care reform will cost more when the Republicans block most attempts at cost savings. You hardly needed an actuary to tell you that.

The real problem here is in allowing the Republicans to frame the issue as simply a matter of cost. Republicans have so altered the political debate that any consideration of spending more money (unless it involves invading other countries or committing torture) is difficult to bring up, regardless of how beneficial increased domestic spending in some areas might be.

If we frame the issue as one of spending money, then of course the Republicans will win. There is no such thing as a free lunch. If Americans can once again look at the issues as adults, then we can look at the real issues. We have the worst health care delivery system in the modern industrialized world. Any discussion of health care should start from the perspective that the United States should be able to do what the rest of the industrialized world does in enabling all of its citizens to obtain affordable health care.

So far the Republicans have no meaningful answers as to expanding health care coverage. They essentially have two proposals: allowing people to purchase insurance across state lines and malpractice reform. The first is basically a way to allow insurance companies to avoid state regulations which is the opposite of what is needed as long as insurance companies are destroying the individual market by finding ways to deny care. Tort reform should be included in health care reform. We need to take advantage of all possible ways to reduce health care costs without reducing quality or limiting choice. While this should be included, tort reform would only have a small impact on overall health care costs and by itself it is not a solution.

We need to look beyond the question of whether health care reform costs money to  looking at the problems which must be solved. Unfortunately the Democrats also reinforce the Republican framing when they make promises which they might not be able to keep to reform health care without raising any taxes on most people. Having a country in which  everyone has access to health care, and nobody has to fear that losing their jobs or developing a serious illness might force them into bankruptcy, is something which is worth paying for. If the rest of the industrialized world can do this, the United States should be able to. Republicans are hoping that they can fool enough people with their spin on this report to avoid having to answer the real questions on health care reform.