Health care reform: Deja vu all over again

Eleven years ago, I wrote a brief history of health insurance for the Journal of Psychology and Christianity (“Managed care: It’s like deja vu all over again,” 1998, vol. 17, 131-141) as a part of special issue on managed behavioral health care.

I thought of that article this past week while reading various news reports about President Obama’s push to enact some version of health care/health insurance reform. I argued in that paper that managed care was one on many private sector arrangements designed in part to avoid government run national health insurance (NHI).

managed care

Obama says health care reform will lower costs, however, the Congressional Budget Office says reform as envisioned will spike the deficit by over 200 billion during the next decade.

For some reason, Democrats want us to believe this:

Democrats insisted the budget analysis ignores savings and Obama’s pledge not to add red ink to the federal ledger.

For about 100 years, the debate has come and gone. When a politician or anyone really says, buy now or else you lose your change, I worry. We needed the bailout now, we needed to bail out GM now, and now health reform now

President Obama urged Congress yesterday to push past their growing doubts and pass a comprehensive health-care reform package this year, saying that a better opportunity to remake the nation’s health-care system may not arise for generations.

Here is more on the CBO estimates. If you can read this and believe the current plans will be cost neutral, then you have more faith than I do.

The concern I have at this point in history, is that the private sector seems to have rolled over and may expect that NHI is truly inevitable this go around. The hope to offset more federalization of health care probably rests with conservative Democrats and resistance to two main policy points: one, the increases to budget deficit as noted and two, the proposed inclusion of abortion in any federal plan.

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  • http://nojam75.blogspot.com Norm!

    I don’t think anyone really believes universal health care will be cost neutral. Of course it’s going to be an enormous cost to the federal budget. Like Social Security, Medicare, and military, healthcare will be a major cost. However, health care is already a major, bloated, inefficient cost to our economy — it just isn’t listed in the federal budget.

    I shop for my employer’s healthcare plan annually and have watched the insurance plans double our premiums while diminishing coverage. I also noticed that an increasing number of our customers carry health care collections on their credit reports. Health care collections are so common that our screening vendor suggests that we disregard these. I think many employees (including myself before I was tasked with paying the bill) are clueless as to what their employers are actually paying for their health plan.

    The president was elected to reform health care. Conservatives had eight years to propose their own health care plan and even now have failed to propose their own plan — other than tired rhetoric. Denying women the right to make their own health care choices would seem to be a desperate conservative tactic.

  • http://www.wthrockmorton.com Warren

    Norm! – Are you saying Obama doesn’t believe his own rhetoric?

    I have no expertise in the area of macroeconomics but given that the costs are going to occur whoever pays or is responsible, then I don’t see the advantage of having a government option for people who already have insurance. For people who do not, it might beat the emergency room but I am not convinced that utilization patterns will change as quickly as the administration hopes.

  • Mary

    I doubt utilization patterns will change quickly and it will cost money. Like Norm! I see the dings from helathcare costs on credit reports all day long. I don’t know the answer but I do know we are 24th in the world in terms of infant mortality, we do not live as long as other western eurpopean countries and obesity and diabetes are out of control. Drug manufacturers get money from the govt to develop drugs and then on the back end pass on more (costs) to the end consumer. While we have some of the best medical technology in the world, most Americans never get to use that technology.

    I don’t know the answer – but something must change. Like you Warren I am suspicious of anyone who tlaks a take it now or never program but in this case, since we have watched the effects of deteriorating health in our population and watched costs rise to the point of being out of reach for most then we have an issue.

  • http://nojam75.blogspot.com Norm!

    Hi Warren:

    Are you saying Obama doesn’t believe his own rhetoric?

    Nope. Obama is correct. The costs of following the conservative plan of doing nothing will far exceed the costs of trying something.

    I have no expertise in the area of macroeconomics but given that the costs are going to occur whoever pays or is responsible, then I don’t see the advantage of having a government option for people who already have insurance.

    You don’t see a benefit for your insurer competing with a government plan? Conservative love to broadly talk about the efficiencies of the private sector and the free market, but the reality is that there is no way to profit in caring for sick, unemployed people. Like police, fire, defense, and welfare, there is no way to provide a costly, vital, necessary public service without taxing others. The only way private health insurers can profit is by denying coverage. It doesn’t take any expertise to recognize that.

    For people who do not, it might beat the emergency room but I am not convinced that utilization patterns will change as quickly as the administration hopes.

    You’re convinced that people would rather wait in a crowded emergency room than go to their doctor’s medical office? Sure, there will always be irresponsible folks who will wait for things to get so bad that they have no choice than to go to the ER. Utilization patterns may take time to change because for generations, our society has said that only lucky folks with a good employer deserve medical attention. But I think most people who have health insurance become more aware of how to get the most out of their benefits.

    BTW, Warren, do you know how much your employer pays for your healthcare plan? What is your plan if you become too sick to remain employed? Have you shopped around for private insurance? Can you honestly say the current, free market system works? We’re basically all in the same boat and most of us are at risk of economic devastation if we face a major health emergency.

    I’m no expert in macroeconomics either, but it seems that our overall economy would improve if employees and small business owners (the real engine to our economy) didn’t have the burden of wondering whether they will have affordable access to health care.

  • Jayhuck

    Warren,

    If you don’t want healthcare reform now, when? We’ve been needing reform since the Clinton’s brought that fact to the nation over 13 years ago. Private healthcare insurance does not work. Most likely we are going to need some combination of government-run and private health insurance companies.

    While we wait healthcare costs skyrocket, waiting time to see doctors and Nurse practitioners lengthen, the time health practitioners are allowed to spend with patients diminishes and more people become unable to afford quality care.

  • Jayhuck

    Norm,

    but the reality is that there is no way to profit in caring for sick, unemployed people. Like police, fire, defense, and welfare, there is no way to provide a costly, vital, necessary public service without taxing others.

    That is, I’m afraid, the ugly truth!

  • Lynn David

    All I know is that I got priced out of my insurance when the company raised the premium to twice to three times what I make from my crops. Then I couldn’t find insurance because of two pre-existing conditions which are death-knells in the health insurance game. Add to that a new chronic illness which has now destroyed a life savings and threatens to return at any time.

    So I guess I am meant to divest myself of a farm which is a livelyhood, should or rather when illness returns.

    But you all in your ivory towers have your insurance…..

  • Mary

    @ Lynn David,

    I hear you.

  • Mary

    Why doesn’t this country focus on prevention instead of just covering the symtpoms – we don’t even cure people anymore.

    Here I am 45 yo, 140 lbs 5’5″, cholesterol levels good, bp is good, no history of cancer or heart problems in the family. And yet, my fat friend who is 5’2″, weigh 350 lbs, has problems like you cannot believe with her feet, ankles, knees etc… has job and pays 450 a month for minimal health care. She has high bp, cholesterol levels out of whack, migraines, etc… I am self employed and cannot afford minimal health care packages because of a pre-existing condition – depression. BTW, the actuaries for my family put them all well over the age of avergage mortality for Americans. This is capitalism at it’s worst. Why can’t I have the same single payer insurance that congress Has?

  • Lynn David

    Thank you, Mary.


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