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Will Health Care Reform Make You Healthier?

Maybe a bit. But not by much. Indeed, the main impact of health-care reform on health may be that if it could contain costs, we'd have money to spend on things that actually do make us healthier. That, at least, is the thesis of an article I wrote for The American Prospect. An excerpt:

Amy and Lane are the sort of entrepreneurs politicians mythologize. Folks who stepped out of the safety of corporate employment, identified a market niche, and filled it. The couple owns a small broadband Internet-access provider in Northeastern Iowa. The work they do matters: A remote corner of a rural state depends on them for connectivity and competitiveness. And they are going bankrupt.

Their finances have not failed because their business has flagged. Nor were they victimized by Wall Street's collapse. Rather, their woes began 17 years ago, long before there was a Google to access or there were download speeds to compare. When Lane was 21 years old, he was diagnosed with cancer. The treatments were vicious: Doctors took a lung, a leg bone, and part of a hip while fighting the disease. But they were successful. Now he is cancer-free. The disease still haunts his life, however: In particular, it haunts his finances. Health insurance consumes 40 percent of the family's income. They have no retirement savings. Loan officers casually mention bankruptcy, a word that breaks Amy's heart. "This is not who we are," she said. "We have done everything we were supposed to do."

Health-care reform, at least as discussed in Washington, is designed to help families like Amy and Lane. Indeed, if their plight sounds straight out of a political speech, that's because it is. Barack Obama told their story in May 2007, when he unveiled his health-care plan at the University of Iowa. This was the situation he chose in order to illustrate the problem he meant to solve. But read it closely. Amy and Lane are not facing a health problem. They are facing a health-financing problem. Reform will make them more economically secure. It will not necessarily make them any healthier.

This is frequently elided in the health-reform debate. Obama's campaign Web page sold his health-reform proposal as "A Plan for a Healthy America." Sen. Ron Wyden calls his bill "The Healthy Americans Act." But for a clearer account of what health reform is really about, consider the congressional committees that have primary jurisdiction over it. In the House, it is the Energy and Commerce Committee. In the Senate, it is the Finance Committee, rather than the Committee on Health, Education, Labor, and Pensions. In both cases, the money committee commands the issue. After all, this is fundamentally an issue of money.

Whole thing here. What do you think?

By Ezra Klein  |  June 19, 2009; 2:42 PM ET
Categories:  Health  
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Wasn't health care reform supposed to also provide health care to those who lack it, as well as reining in costs for those who already have it? That would seem like a feature that actually makes us healthier, and isn't just about money. It is really sad to see questions about how to provide health to millions who lack it subsumed beneath these budget-hawk anxieties about cost increases. I'm not saying the latter isn't important, but it's frustrating to see even center-left wonks like Klein get so caught up in these cost questions that issues of increasing the health of millions of uninsured dont just fall by the wayside, but can't even be remembered! Or does Klein think that all the plans on the table already solve this question that, only a few months ago, used to dominate the health reform debate?

Posted by: Ulium | June 19, 2009 3:03 PM | Report abuse

You made a series of extremely important points but I wasn't quite sure what the central thesis of your article was or how it was supposed to advance the current healthcare conversation. You are becoming an influential voice on this issue nationally and it would be good to see something more focused, though this was an enjoyable read.

Posted by: micahdw | June 19, 2009 3:04 PM | Report abuse

Oi Veh! Yet another problem that would disappear with Medicare for All which not only would be cheaper than anything "on the table", but would be cheaper than what we are now paying.

Posted by: lensch | June 19, 2009 3:32 PM | Report abuse

We need to repeat the distinction between health insurance reform (getting more people insured cost effectively) and health care reform (getting more effective treatments to more people)

Posted by: srw3 | June 19, 2009 3:35 PM | Report abuse

I'm open to the argument, that health care != health, & we should spend the money on other things, after we get universality. Before that, it seems slightly obscene for someone who doesn't have to worry about medical bills warmly reassuring someone who does, that after all they're not missing much, it probably wouldn't do them much good anyway.

I'd also be interested in your take on Dean Baker's article in the Boston Review, which suggested that to some extent the main problem with health care costs is not the amount of care we consume, but the way we pay for it.

I'd also be interested if Obama's team is thinking about increasing the supply of doctors & nurses, especially primary physicians.

Posted by: roublen | June 19, 2009 3:52 PM | Report abuse

i think there are deep questions about health care, quality of life and how much we expect out of our health care system.
as people grow older and require more care, i wonder how it is affordable on such an intense, large scale.
yesterday, i attended a senior event...
at the table i was sitting at, were a group of people from their late sixties to early eighties.
the person next to me was on dialysis, and hoping desperately for a kidney transplant. her husband was almost unable to raise himself out of the chair, shaking, terribly thin and weak, with parkinson's disease.
the person on my left side, had extreme congestive heart failure and peripheral arterial disease and diabetes...and is possibly looking at an amputation in the very near future.
the person next to him, seemed in the very early stages of alzheimer's disease....a sad dimness and unresponsiveness.
the woman across from me was in so much pain, she had to leave early for the doctor, and another person was recovering from very serious surgery.
all of their arms, were frail with big purple clots from blood thinning medications and all but one, had hearing aids and walkers.
this was just one table in a room of two hundred seniors.
between weeks and weeks of hospital stays and even longer times spent in convalescent homes, the bills go into the hundreds of thousands, even the millions.
when i left that luncheon, i was glad to get outside.
and i thought, human beings are the only things in nature that work and struggle against the natural processes of time and aging.
it left me feeling not just confused about the whole health care system, but about how we live as a culture....what our expectations are as individuals and as a society.
i came to no conclusions, but it left me perplexed about many things.
all of these people were mostly middle-class. all have received extraordinary care....and just being in that room, one
could attest to the miracles of our health care system, and a commitment to prolongation of life, that keeps these people alive, and edging forward, ever so they stoop and clutch their walkers, and catch their breath.

Posted by: jkaren | June 19, 2009 4:44 PM | Report abuse

if we had socialized medicine almost 20 years ago when he developed the cancer would he have been treated in time to live this long?

That's the really interesting question. I highly doubt it.

Individual mandates and more regulation on insurers would help. Socialized medicine and its lack of speed and coverage of such drastic treatments would have likely let him die.

Posted by: visionbrkr | June 19, 2009 9:24 PM | Report abuse

"That's the really interesting question. I highly doubt it."

Really? Why do you doubt it? Because you've been led to believe that doctors working in actual healthcare systems (i.e. not the US) give up on young cancer sufferers? Because Rudy Giuliani told you what to think?

For what it's worth, I have a friend in the UK who is in her early forties, and has had three hip replacements, the first dating back to her teens. And I know plenty of people whose cancer treatment would have made them uninsurable in the US, who are still with us today. They had timely, thorough care, assisted by the fact that they never had to forego the checks that led to their diagnoses.

So cut the crap. You don't know what you're talking about.

Posted by: pseudonymousinnc | June 20, 2009 4:18 PM | Report abuse

So cut the crap. You don't know what you're talking about.

Are you serious? I have my story as well. I have a client whose employer is a multinational and he was based in the US in Virginia and transferred last year to Ontario. Soon after his wife became pregnant with their second child and the first was a high risk here in the US. She was deathly afraid as she was told she wouldn't be seen by her OBGYN until the 22nd week of the pregnancy. THE 22ND WEEK. He begged and pleaded with his employer to transfer him back to the US, even offering to offset the cost of the move which they declined. They moved him back and she had her child after being put on bedrest for the last month. I'm glad for him he did.

Posted by: visionbrkr | June 20, 2009 10:21 PM | Report abuse

Well done, visionbrkr: you've just successfully compared an apple and an orange.

Posted by: pseudonymousinnc | June 20, 2009 10:56 PM | Report abuse

If you were right than Europe and Canada were far beyond us is life expectancy and other health statistics, but it is the other way around. US is the worst among the developed countries, while we are spending more money on health care than anybody else. Something is wrong with the system and we have to fix it.

Posted by: evelyn3091 | June 21, 2009 2:19 AM | Report abuse


so if you don't agree with my opinions you get nasty about it? (ie cut the crap?) There's no need to be obnoxious about it. And the stories are NOT apples and oranges. Let me give you another example for you. A friend had testicular cancer here in the US and was treated for it. Since he needs biannual catscans and petscans to ensure he doesn't have a re-occurance. Does he get that in Canada or England? I doubt it.

Again I'm entitled to my opinion just as you are. Last time I checked this was a free country for now.

And Evelyn,

i thought it interesting that in watching testimony on cspan that when you factor in the murder and accidental death rates in the US the US is actually better off than the rest of the world. That also is the case even though we're some of the unhealthiest (fattest) folks around. We don't eat well and we eat more processed foods than most other countries. There are many factors that go into the equation. As far as the number of top notch hospitals/facilities nowhere matches the US and I wonder if that will go away if the changes go too far. Yes other countries have some but we have the Mayo Clinic, Cleveland Clinic, Johns Hopkins, Sloan Kettering Cancer Center and others. Other socialized countries don't have ALL that.

Posted by: visionbrkr | June 21, 2009 2:37 PM | Report abuse

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