Young: Health care realities vs. free market fantasies
Special to the Daily
Black helicopter watch can get lonely, even if there’s one always just over the horizon.
Any day now, for instance, President Obama will assemble the death panels of his health care designs, appointing the extraterrestrials we suspected he would, to a thousand cable-televised told-you-sos.
So much that was evil, we were told, would dawn with the Affordable Care Act. Most assuredly it wouldn’t include 30 million newly insured Americans not even one year on.
One loses track of all the things the ACA’s most ardent foes assured us would happen. On this occasion, however, it’s worth looking at one claim uttered over and over, and which will be uttered over again.
The claim: that the ACA used Medicare as “its piggybank” — that it took, stole, confiscated, filched, pilfered, more than $700 billion from what was set aside to care for your grandparents and mine and to assure the future of the Medicare trust fund.
That claim not only is fallacious but doubly so. Most of the money in question is calculated savings on hospital reimbursements under Medicare, a crash diet, if you will, regarding overcharges that have been a national scandal. Not only do these savings mean less of an obligation for taxpayers, but as Factcheck.org explains, they significantly “prolong the life of the Medicare trust fund.”
That’s a good thing. So is this: With tighter Medicare criteria setting the standard, increasing numbers of hospitals are reining in costs, saving themselves and their patients money in the process.
Kaiser Health News recently focused a report on hospitals in Utah that had established a database to track the cost and quality of services to all their patients. Instead of the typical cost run-up, Utah hospitals actually spent less — $2.5 million less — in the last year, without sacrificing quality.
One big factor in this: constructive pressure from the Medicare system to do things differently.
Yeah, we know — government ruins everything. Well, when Time magazine’s Stephen Brill spent a year studying why hospital bills were so insanely out of proportion, he found a hero and a model for getting us out of this mess: Medicare. Every hospital bill abomination was cast in stark contrast to Medicare’s clear-eyed price-setting mechanism.
Where these comments are headed is this: Some readers don’t want to hear it, but the answer to what long has ailed health care is, yes, more government.
Health care is something the free market cannot do by itself.
It cannot care for people scraping along in the ranks of the poor and the elderly. It cannot care for people with pre-existing conditions, or those who have no employer-based health coverage and can afford no alternative.
The free market cannot regulate prices fairly in health care, largely because actual competition is alien to the industry, whether it be making drugs or removing tonsils. The consumer is captive to virtual-to-absolute monopolies.
And anyway, hospitals are no more private enterprises than is the Pentagon. They are inextricably linked to government and public policy. That is never going to change. So, let’s get real and get the most out of what government can do to make health care fairer and more equitable.
What an odd statement it was when the Supreme Court ruled that a business owner could apply religious tests to what kind of health coverage employees could have. But welcome to the odd coupling of private and public interests inherent in ACA’s employer mandate.
And that says nothing about the role of private insurers who can, and did, drop policy holders on a moment’s notice.
Don’t want the government telling employers what they should do? Support a single-payer approach. Get real. To meet the needs of the uninsured and hold down health care costs, free market fantasies don’t work. They never have. They never will.
Longtime Texas newspaperman John Young lives in Colorado.Email:firstname.lastname@example.org.
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