TW: The premise of this piece is somewhat flawed. She asserts universal care will require either- tax increases, reduced payments to providers or rationed care. What she misses is that uninsured folks receive a great deal of care already some of which they pay out of pocket and some of which just gets absorbed indirectly into the system when they are treated but do not pay. Furthermore, folks who avoid care due to lack of insurance may create worse health care bills down the road due to preventable but untreated symptoms etc. The challenge is converting those costs from the nebulous to the quantifiable will in fact be very challenging. And yes some uninsureds will begin consuming more health care than they did previously.
But at some point I agree with her premise, our health care costs cannot continue increasing faster than our income with crowding out other consumption and/or bankrupting the nation. Taxes may go up some but ultimately that cannot be the answer (if the costs rises faster than income then taxes would have to increase to unfeasible levels). So greater efficiency and/or rationing will have to happen. The more efficient we can become the less rationing that will be necessary. Neither the Dems nor the Republicans are being honest about this equation especially the rationing part.
From Business Week:
"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. Is there a politician willing to have an honest discussion with the public about these tough choices?
The CBO estimates that covering the uninsured could add anywhere from $1 trillion to $2 trillion to the federal budget over 10 years. On top of that, government economists expect Medicare to run out of money in 2017 if current spending trends continue. "When do the adults show up and say the part about needing to eat our vegetables?" asks Benjamin E. Sasse, Asst. Sec. of HHS from 2007 to 2009. "Every politician wants to solve the uninsured problem, but that's the ice cream. Being honest about the price is the spinach, and they're ducking."
The Senate Finance Committee did quietly release a 40-page document on May 18 laying out payment options for universal coverage. They range from taxing employee health insurance to fining companies that don't offer benefits to levying taxes on alcohol and soda. None will be an easy sell.
Economists tend to favor a tax on employee health-care benefits, which could bring in more than $200 billion a year (now these benefits are tax-exempt). But given the shaky economy, Congress is unlikely to take any action that might encourage companies to drop employee insurance or reduce a worker's take-home pay, says Robert J. Blendon, professor at Harvard University.
...How about the white coats? Hospitals and doctors account for 62% of the nation's health spending, but they have shown little interest in taking a hit to their income.
...Then there's rationing. Actually, there's not. Telling patients they can't have every treatment they want is not remotely on the table. There is some hope that patients may respond to financial incentives to choose healthier lifestyles, but—given that two-thirds of adults are overweight and half of all patients do not take their medications as prescribed—nobody is banking on it.
In policy circles there's some optimism that the political class knows it has to address the funding question soon. "In both the Administration and Congress there are a lot of people who understand the need, at a pretty sophisticated level, to bring down costs," says Douglas A. Hastings, a Washington health-care attorney with Epstein Becker & Green. Now all they need to do is educate the voters."
http://www.businessweek.com/magazine/content/09_22/b4133000817326.htm?chan=magazine+channel_news
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