Fix healthcare versus fix the economy?

February 2, 2009  |  General

The debate is on over this question: does the financial hole we’re in make any healthcare reforms unaffordable in the near term? Most observers say we’ve got two major problems to solve — access and cost.

Many Americans don’t have access to care, primarily because they don’t have any insurance. Estimates vary of exactly how many people this is, as do explanations for why they don’t have insurance. Free market conservatives assert that the number of uninsured Americans is manageably small. Further, they believe that for a significant chunk of these people the reason they don’t have insurance is because they choose not to buy it. The more liberal viewpoint, which I share, is that the number of uninsured really is at unacceptably high levels, and the reason it is that high is that insurance costs too much. This especially affects the self-employed, who must buy insurance for themselves, or those who work for small companies, which increasingly cannot afford to offer their employees healthcare benefits. Tying healthcare to employment, the standard way of doing things, causes major problems and inequities.

It is pretty clear, as became apparent in Massachusetts when they enacted their own healthcare reform, that increasing access to care caused an immediate torrent of pent-up demand from people who had been putting things off because they had no insurance to pay for it. So in the short term, at least, costs clearly go up when you increase access. But the alternative is clearly unacceptable, at least to me — controlling overall healthcare costs by denying access to needed care is an inhumane and shortsighted approach.

The rub, of course, is that as a society we ultimately must deny some access to care because we cannot afford it all. Healthcare costs already constitute a higher proportion of our GDP than any other country’s, and the trend is getting worse. The key is to eliminate payment for those things that don’t work. Most experts agree that a huge proportion of our healthcare dollars go for things of marginal or no benefit.

Since all this will cost money, should we put it off in these difficult fiscal times? No, says the Obama administration and many other healthcare wonks. Their idea is that reforming healthcare is intimately bound up with any economic recovery package. And just speaking politically, times of crisis have often been times when people are more willing to make dramatic changes in how we do things — ordinarily, we resist change, something even Machiavelli knew, and which has been called the “law of reform.”

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