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The Status Quo Alternative

Good column from Steve Pearlstein today:

Among the range of options for health-care reform, there's one that is sure to raise your taxes, increase your out-of-pocket medical expenses, swell the federal deficit, leave more Americans without insurance and guarantee that wages will remain stagnant.

That's the option of doing nothing, letting things continue to drift as they have for the past two decades as we continue to search in vain for the perfect plan that would let everyone have everything they want and preserve everything they already have while getting someone else to pay for it.

So the next time you hear someone throwing a hissy fit because health reform might raise taxes on some people, or steer people into managed care, or require small businesses to contribute $2 a day for each employee's coverage, just remember to ask yourself: And that's compared with what?

Another way to say this is that health-care reform includes a couple of serious efforts to cut costs in the long-term. One is the effort to take Medicare reform away from Congress. Another is the mix of comparative effectiveness research and health IT. Another is insurer competition in the Health Insurance Exchange. Another is the public plan. There are reasons to believe these policies will work and reasons to believe they won't. But there is no reason to believe that doing nothing will obtain a different result then it's already produced.

By Ezra Klein  |  July 22, 2009; 10:37 AM ET
Categories:  Health Reform  
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Comments

The GOP isn't in favor of the status quo. They advocate eliminating waste, fraud and abude. And elimination by tort reform of trial lawyers bankrupting the country. And returning competition to health care through outlawing Medicare and Medicaid.

That's the reform we need and can afford.

/snark

Posted by: JimPortlandOR | July 22, 2009 10:53 AM | Report abuse

So then what exactly is the issue with attacking the problem of cutting costs first? If a health exchange really is going to be a panacea of savings then what are the barriers stopping the creation of that now? If medicare costs can be contained now then whats the holdup?

Posted by: spotatl | July 22, 2009 11:03 AM | Report abuse

This presents a false choice: do nothing and suffer or pass health care reform. How about the option of fixing the programs that currently exist (Medicaid and especially Medicare) before creating massive new programs?

Ezra don't you find it ironic that the President and Orszag argue that the best way to reform Medicare is to remove Congress' decision-making authority at the same time that Obama wants Congress to pass a massive increase in health care entitlements? Congress can't mange the entitlements that already exist.

Posted by: mbp3 | July 22, 2009 11:53 AM | Report abuse

It's the devil you know versus the devil you don't know. I think we have in many respects failed to convince the public that the reforms proposed will be an improvement over the status quo. Personally I think it will be, but then I have had to shop for an individual policy on the open market before. Not everyone has had that pleasure. Toss in a 25 year old benign pre-existing condition and it pretty much turns you into a foaming at the mouth socialist overnight! At least as far as health care is concerned.

Posted by: luko | July 22, 2009 1:19 PM | Report abuse

We shouldn't need "insurance" to pay for ordinary health care. We need to attack the cause of the rising health care costs at their core- there is very little downward pressure on price from consumers because of the indirect payment systems. The incentives are backwards. The fixed price pressure placed on the system by Medicare has resulted in perverse over-treatment, where doctors arrange as many visits and tests as possible to make up for the thin margins.

We need self rationing. It works in just about every other area of life, but poor regulation is preventing it from working in this market.

Posted by: staticvars | July 22, 2009 3:02 PM | Report abuse

I looked at your post describing the four ways reform was going to reduce costs.
1. Why is health IT any more likely to reduce costs, except as a secondary effect from the documented reduction in productivity for doctors? Why wouldn't it be just as likely that the low cost area like El Paso become more like the Partner's Healthcare (McAllen on the Charles) than like El Paso? There are few patients as obese and as co-morbid as McAllen in Boston, and I bet those that are, cost the system as much, or more with Partners than they did in McAllen. That was why the comparison was with sleepy, behind the times, El Paso, not with Boston.

IT is going to remind you to do a lot of expensive, beneficial but marginally cost-effect treatments --- some of these are being ignored currently. And this saves money?

2. MEDPAC is going to succeed in convincing doctors that expensive treatment shouldn't be pursued how..? .. by not paying them? Isn't this the same old HMO --take aspirin, no need for an MR or an orthopedic surgeon --- wine in government bottles? How many patients are we going to convince to take the cheaper radiation therapy when the rich still get the experimental brain surgery?

3. Public assistance option seems to be another price control idea.

Missing is the realities. Care must be scaled back. That means lowering, not raising the standard of care. Rationing is in our future, if not now, soon.

Posted by: ChristopherGeorge | July 22, 2009 8:28 PM | Report abuse

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