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Oct 28 2009, 2:35 pm

The Best Health Care Reform is Impossible

I'm reading Bruce Bartlett's crowd-sourced interview with Economix readers, and this part strikes me as a reasonable -- and familiar -- conservative critique:

I also believe the administration has done a poor job of addressing what I think is the biggest problem with the American health case system: It costs too much for what we get. We spend in total twice as much of our gross domestic product on health as most other major countries without getting much in return for the extra spending.
Hey, that reminds me of something!

Two weeks ago, Ross Douthat wrote pretty much the same thing in the New York Times, before suggesting that we scrap the current apparatus and replace it with a new system where Americans pay for day-to-day medical out of their own pockets and the government provides "catastrophic insurance":

Three major problems plague American health care. The cost of premiums is eating up an ever larger share of take-home pay. The cost of our public health care programs is eating up an ever larger share of the federal budget. And millions of people who need insurance are priced out of the market.

Now that Max Baucus's version of health care legislation has been blessed, at least provisionally, by the hands of Senator Olympia Snowe of Maine, it's increasingly likely that Congress will pass reforms that address the third problem, while making the first two problems somewhat worse.
And hey, that reminds me of something else! Yesterday Gregg Easterbrook, in his weekly ESPN column that occasionally touches on public policy, said pretty much the same thing:

Gradually transitioning to a system in which most people carry catastrophic-cost medical insurance but pay the rest themselves could rationalize health care economics while restraining costs, because the wasteful paperwork aspect of the system would decline.
Three moderate conservatives, one critique: The health care reform bill doesn't do enough to bring down costs for the government or for individuals, and the only solution is to effectively blow up the system. The only problem with this idea is that it imagines a world without politics, or special interests, or elections. As Megan McArdle has said on numerous occasions, cutting doctor reimbursements loses you the AMA. Cutting services loses the AARP. Trying to punish plush plans loses the unions and the rich. Benefits are sticky, and elections are frequent, and it's very, very hard to scrap parts (much less the whole) of a system worth more than $2 trillion, because most dollars a reformer identifies as "waste and abuse" some group will identify as "my meal ticket."

All of which is to say that somewhere down the line, the general consensus might be that health care reform failed to boldly cut costs, bend the curve and revamp a "broken" system. Somebody will try again. They might even succeed in changing the system more radically than the Senate plans envision. But let's at least agree that barring some tangible health care disaster, it will be a Herculean, if not impossible, task.

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Comments (4)

Paul in Athens

"Pay as you go"


Wait. I've heard that somewhere before.

See Machiavelli's Law of Reform...

So your point is what? That ObamaCare is bad, but real reform is impossible, so "Long Live Politics! We don't have to make sense!"?

Some would say that this situation is exactly why you want smaller government. Big government just guarantees this kind of special interest distortion of an entire industry. You could also argue for more state-level action. At least then, you'd be able to move to get away from bad systems (like New York or Mass. health care.)

If ObamaCare passes, Congress will exempt itself, and the rich will buy private care from "boutique" clinics and go overseas for expensive surgery not covered here. It's the middle class and poor who will have to put up with the monster we are creating now.

And since this will either drive the country into bankruptcy, or result in severe rationing of care, I'm with the silly Republicans. Doing nothing would have been better than this.

Julian Lieb,M.D

Paradigm shifts that can radically improve the quality of care, thus reducing utilization, are capable of significant cost reduction. A paradigm shift, however, often faces an uphill struggle to win acceptance and implementation.

Databases such as Medline and Pubmed contain more than sixty articles on the remarkable anticancer properties of antidepressants. Antidepressants kill cancer cells, inhibit their proliferation, convert multidrug resistant cells to sensitive, protect nonmalignant cells from damage by ionizing radiation and chemotherapy toxicity, and target the mitochondria of cancer cells, while sparing those of healthy ones. Antidepressants can arrest tumors even in advanced stages, occasionally eradicate them, and significantly extend life. Depression significantly increases the risk of cancer, and accelerates and increases its mortality.

Killing or growth inhibition by antidepressants of the cells of such treatment resistant disorders as gliomas, lung and liver cancer, resistant lymphomas, and inflammatory cancer of the breast have been documented. In a controlled study, an antidepressant arrested lung cancer in advanced stages, and significantly extended life. More forms of cancer will surely be added to the list. Cancer is not a hundred different diseases, but one disease with a hundred variations.

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