No Cost Controls Without Coverage Expansions
"As a practical, political matter," writes Paul Krugman, "controlling health care costs and expanding health care access aren’t opposing alternatives — you have to do both, or neither." That "practical, political," is an important distinction: You could, in theory, cut costs without expanding coverage. You just can't do it in practice. Krugman explains:
Why does meaningful action on medical costs go along with compassion? One answer is that compassion means not closing your eyes to the human consequences of rising costs. When health insurance premiums doubled during the Bush years, our health care system “controlled costs” by dropping coverage for many workers — but as far as the Bush administration was concerned, that wasn’t a problem. If you believe in universal coverage, on the other hand, it is a problem, and demands a solution.
Beyond that, I’d suggest that would-be health reformers won’t have the moral authority to confront our system’s inefficiency unless they’re also prepared to end its cruelty. If President Bush had tried to rein in Medicare spending, he would have been accused, with considerable justice, of cutting benefits so that he could give the wealthy even more tax cuts. President Obama, by contrast, can link Medicare reform with the goal of protecting less fortunate Americans and making the middle class more secure.
The other point here is that because the votes of the vast majority of Democrats are essentially assured on health-care reform, the anxieties of the few swing votes at the edge of both parties end up getting a lot of media coverage. But if you tried to do cost control without coverage, you wouldn't be worrying about getting Ben Nelson and Joe Lieberman aboard. You'd be worrying about the 40 senators to their left.
The crucial votes -- the Ted Kennedys and Henry Waxmans and Jay Rockefellers and Chris Dodds of the world -- are not interested in making painful changes to the health-care system that are not leavened by policies to cut the number of uninsured and protect people from the vagaries of the insurance market. To achieve those priorities, they might be willing to make substantial changes to also cut costs and make sure coverage is affordable. But you don't get one without the other.
July 24, 2009; 5:22 PM ET
Categories: Health Reform
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