Sunday, July 26, 2009 | 2 a.m.
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Health care, part two.
It is now clear that the attempt by the Obama administration to pass meaningful health care reform by August is more fiction than fact. Because of how hard this challenge is and will continue to be, final action by the summer recess is officially out of reach. Not that it won’t, can’t or shouldn’t happen, it is just that there is a lot more to say about it, much more than the next couple of weeks can adequately allow.
Since I convinced most people who read my last health care column that government, in and of itself, is not the culprit but, perhaps, the only viable catalyst in the equation, other questions have arisen — how much will it cost, how do we pay for it and, specifically, who will pay for it?
I don’t have those answers because they are still being wrangled through the very messy legislative process. That’s a process, by the way, where
90 percent of what Congress is doing doesn’t get reported, and 90 percent of what it isn’t doing does. A most significant “trial balloon” was launched a few days ago when it was suggested that the wealthiest Americans be surtaxed to pay for the health care of those less well off. To say that created a firestorm is an understatement.
What that also did was cause numerous Obama health reform supporters — Democrats, Republicans, independents, wealthy, not-so-wealthy, and those hoping one day to be wealthy — to go nuts! And the inevitable question came to me. What did I think?
So, let me tell you what I think, part two.
I realize the Congressional Budget Office concluded that President Barack Obama’s plan would not save trillions but, rather, cost trillions more than so far has been advertised. That not only causes many Americans to pull back from their support of reform but also scares many others into believing those costs will be sucked directly from their checking and savings accounts.
There is a good reason for this kind of deficit accounting, however misleading it can be. The CBO cannot score that which it cannot see. In other words, the vast savings that everyone knows will occur as our nation grows healthier over time cannot be evaluated today because no one really knows how to count those “what-if” dollars.
And, yet, any health insurance company worth its salt these days is putting as much or more emphasis on preventive medicine as it is on paying for what continues to ail us. They know that if they can keep us healthier — by teaching us how to eat better, exercise more often and make better lifestyle choices (less sugar, no smoking), the longer we will stay healthy and the fewer times we will need to draw upon the expensive part of our medical industry.
We all know that means trillions of dollars saved — a portion of which goes into the insurance companies’ pockets. We all also know that we cannot quantify those savings to the degree necessary to count them. But we do know that we have to include the likelihood of those savings over time or there is no reason to reform the health care system in the first place. After all, it is the steady escalation of health care costs that will bust this country’s budgets in the years to come.
When Sen. Daniel Patrick Moynihan of New York was helping President Lyndon Johnson create the Great Society, it was obvious to him that the legislative effort was a two-parter. One part was the benefits that citizens who needed help would receive and the other part was the responsibility this country would require of those who got our help.
History has informed us that the first part — always the easy part for Congress because it required nothing more than giving people something for nothing — was accomplished with the promise of the responsibility part to follow. That didn’t happen. As a consequence, the welfare system grew well beyond our treasury’s ability to pay for it and the leg up for people in need became a handout for people who no longer felt the need to be responsible for themselves. This country lost on both counts.
We are at that point again, assuming health care reform does get done. What is critical here is that the help and the responsibility happen at the same time, lest we have another 30-year welfare debacle on our hands.
This time, though, responsibility is easy to define. First, everyone who gets health insurance must pay something for his health care. I don’t care if it is as low as a $5 co-pay — knowing others may have a $50 co-pay, or more — everyone must pay something based on his financial circumstances. This will lessen the opportunity for abuse.
Second, here is where the answer to my friends’ question about why should those with money pay for someone else’s health care coverage, especially when bad health decisions make those costs so much higher. Everyone must pay for his insurance based, in part, on his life and health decisions.
It is clear that those who are obese have vastly worse health outcomes than those who are not. Those who smoke have far worse health histories than those who don’t. And those who make other lifestyle decisions that have adverse effects on their long-term health do so knowing they will spend more to preserve their health over time.
I am not talking about those whose health is adversely affected through other causes, just lifestyle choices. Simply put, those who choose unwisely should pay significantly more to get better. That is called responsibility. And, yes, I realize that I am being just a bit hypocritical when I say this because, clearly, I am asking that people do as I say and not as I have done.
But this effort is not so much about me and my peers as it is about the next generations. The massive savings will happen over the next few decades, not the next few years. That is when we will reap what President Obama and the Congress are trying to sow in the fields of health care reform.
It is also true that if we continue to do nothing, as those invested in the status quo, specifically the health insurance companies and Big Pharma, want us to do, then the costs of the system will simply and unceremoniously break it.
So, something will get done. Something has to get done. And, yes, it will take more time. It must also reflect the need for people to be responsible about their health care decisions and pay their fair share toward it.
In the end, though, it is a health care prescription we can live with.
Brian Greenspun is editor of the Las Vegas Sun.
