One thing this bill or any other would not do, though, is end the controversy over US healthcare. The battle would move to new ground. The argument over access to health insurance would subside - this would be Mr Obama's lasting success - but the argument over paying for it would become even more intense. The committee's bill conforms to Mr Obama's demand that it be "deficit-neutral", but for the most part only pretends to deal with the costs...
[T]he bill, if it passes, is unfinished business with a vengeance. The implication is clear: here is one more reason why US taxes will have to rise. If Medicare recipients resist cuts in their services, as they will, higher taxes will be needed to pay for the subsidies. Reducing the subsidies is not the answer, because this will worsen the insurers' risk pool, raise health-cost inflation, and roll back gains in coverage.In the end it should come as no surprise that providing wider access to health insurance is going to cost taxpayers money, but the advocates of this change - to repeat, a desirable and long overdue reform - are doing nothing to prepare the country for this unavoidable result.
This column by Ross Douthat is on the same page so far as financial consequences are concerned. He advocates a more limited form of universal access--to coverage with a very high, income-related deductible, or so-called catastrophic insurance. As he says, this has been proposed by Martin Feldstein and Brad DeLong, conservative and liberal respectively, so the idea has cross-party appeal.
There's certainly a lot to be said for this approach. Feldstein and DeLong differ in important ways (DeLong wants to shut down private health insurance altogether) but they agree that the taxpayer should pay for healthcare expenses above a high threshold, and that the tax deduction for employer-provided insurance (which costs more than $200 billion a year) should be abolished to pay for it. Either of their plans would strengthen the individual incentives to economise up to the threshold. I only wonder if a deductible as high as they envisage (15% of gross income; DeLong favors an income-tax increase of 5 percentage points on top of that) could be made to stick.
It’s time to stop talking about healthcare reform and start SINGING about it!! See “Healthcare Fighting (King Fu Mix)” at http://www.youtube.com/watch?v=8nc1VwJOb9Y
The problem with high deductible insurance is that it discourages people from getting medical care and I know from experience that could be fatal. Last year, my 21 year old daughter was diagnosed with acute leukemia at almost midnight, in a hospital emergency room, having lost half her blood. That was a Wednesday night. The Thursday before, she had been playing a sports game. On Saturday she wasn't feeling well and had a nosebleed. She called our family health practice and the doctor on call said she should buy a humidifier. On Monday, she went to the university health clinic and they said she had a flu; on Monday afternoon, she came home andwent to the family health practice and the doctor gave her a prescription for antibiotics.
We have very good insurance and did not hesitate to seek medical attention. Our problem was that primary care doctors do not suspect serious illness and I have heard many similar stories in the last year. But when we knew she was getting worse, we went to the emergency room and they do every test there to cover themselves. I know there are people with acute leukemia who actually die because they are afraid of the costs and think that they'll get better on their own eventually. By the time they make it to the emergency room and are diagnosed, its too late. On one of the Facebook pages I visit, a young woman posted that her mother died of a heart attack shortly after (finally) going to the emergency room.
So, I don't think high deductible insurance is a smart idea for the American people. When I have an occasion to talk about getting sick, I tell people: Go to the emergency room. Its a terrible, ignorant disservice that the news media has picked up the "Emergency room abuse" line. Thats what my daughter's oncologist told us to do if she wasn't feel well. The emergency room runs every test to cover themselves, he said. You can die waiting for a primary care doctor to diagnose you (my daughter's family health practice doctor didn't even do a blood test). And you can die if you are afraid to run up $500 for an emergency room visit (thats about what you'll get billed for a pretty ordinary emergency room visit).