The first way to talk about health care reform is to enumerate exactly where we are going to come up with this money in the first place. Catherine Arnst from BusinessWeek distills this argument neatly down to a sentence:
When considering proposals for extending health-care benefits to 47 million uninsured, keep in mind that there are only three ways to pay for universal coverage: Raise taxes, cut payments to medical providers, or ration care."As Arnst points out, there is an inauspicious silence on all these methods. Some writers will admit that taxes have to go up sometime, certainly on the rich, and maybe on many more. Ezra Klein has argued that rationed care has worked in places like England, and Orszag seems to be peddling the more-is-not-better argument before Congress. But it seems impossible that a health care reform bill could come with the word "rationing" on the label. This is America. More is more, period.
Another argument is that we don't need to pay much attention to the politically impossible cuts, because spending more money now will save us money later. So we have Jonathan Chait and Jonathan Cohn of The New Republic citing a Commonwealth Fund study that sees Obamacare saving $3 trillion in 10 years, and a paper by an Obama economist saying electronic medical records alone will save $600 billion in the next decade. Chait doesn't mention any methods for saving money upfront. Cohn finds them, names them, and ends with calling them "tough political tasks." In other words, spending now is saving later. Subtraction-by-addition is the new fiscal conservatism.*
I hope the TNR's Jonathans are right. And their studies could be 100% accurate, or even understate the benefit of expanded, streamlined care. But projecting savings in health care just such a game. Remember when health care officials gathered in DC to say they discovered $2 trillion is savings? That seemed fishy too, and a Slate analysis found that their promises would realistically only save about $4.32 billion. That's not a rounding error, that's 99.98% lower than advertised!
I'm of the mind that health care reform is issue 1B after stabilizing the financial sector. But the gravity and necessity of health care reform should not obviate the also-necessary debate about where we're going to find the money now.
*Subtraction-by-addition (that is, saving a lot of money later by spending a lot of money now) is also, it seems to me, the philosophy behind education reform and climate change policies.
Derek Thompson's analysis of the health care debate is missing a key point. By moving toward a single-payer healthcare system, we could reduce costs through improvements in efficiency, without changing the services offered or the structure of the providers who offer them.
According the website of PNHP, Physicians for a National Health Program (http://www.pnhp.org/), "[P]rivate insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."
I find it incredibly frustrating that this type of reform seems to be frequently missing from the current discussion on health care reform. Everyone who is participating in the public debate on health care should take the time to be informed on the full range of reform possibilities. A couple of years ago, I took a healthcare policy seminar at the University of Vermont, where I am a student (http://learn.uvm.edu/hm/). I have found it invaluable in giving me the tools to understand what our options are in health care reform.
Thanks for your comment. To respond, I'd say a couple things.
First, moving toward a single-payer healthcare system isn't like teleporting to another planet. Realistically, it will be more like taking a clunky NASA ship to another planet, and that trip is going to be long and expensive. Yes, we stand to save money once we've arrived, but the journey is hellish politically and expensive.
Second, what PNHP offers is another estimate of subtraction by addition, and by assuming that we can cut out the private insurance industry and move to all-electronic records in a jiffy, it's not factoring in the short term costs or the likelihood that what passes in DC will be anything like the kind of system they have in mind.
By all means, it is important and instructive to learn about the different kinds of health care proposals, but can we really assume that, given the incredibly expensive care that exists already and the small chance that either insurers or patients will want to give up profits or care that they've grown accustomed to, that we'll be able to rely on a "pays for itself" approach to health care reform? (That's an open question, not rhetorical)