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Mon., Dec. 17, 2007

A health care reform window

Hillary Clinton talks about health care reform in terms of “American values, American families and American jobs.”

Barack Obama talks about health care as a “right for everyone, not a privilege for the few.”

John McCain talks about making insurance more affordable “by fostering competition and innovation.”

Uwe Reinhardt talks about outrages.

The Princeton economics professor tells of a hospital patient charged $9,000 for a night in the intensive care unit and $791 for stockings that run $12 at a drugstore. He tells of a father who sought treatment for his son’s infected eye and got billed $1,200.

“Is this what America stands for?” he asked. But it wasn’t really a question.

“This is not what this country stands for, this is not what my boy (a Marine who served in Iraq and Afghanistan) fought for,” Reinhardt told editorial writers from around the country at the University of Maryland’s Knight Center for Specialized Journalists.

For anyone who’s paid a hospital bill lately, been faced with insurance premiums almost doubling, or agonized over how to afford medical treatment on a tight budget, health care reform isn’t an abstract policy debate. And the presidential hopefuls, both Democratic and Republican, are acknowledging that it’s an issue that could sway voters in November – as well it should.

In the current health care system, spending per capita has increased about 4.5 percent a year for about four decades, much faster than the 2 percent annual growth of per-capita gross domestic product, Reinhardt explained.

“While we as a nation can afford this spending, the lower middle class can no longer afford it,” he said.

And increased spending doesn’t necessarily buy increased quality of care. A Dartmouth Medical School analysis of Medicare, which covers older Americans, found vast disparities in payments – but they varied based on geography rather than on how sick the patients were or how good the treatment was.

Yet payment structures, for government-subsidized and private insurance, reward use of expensive tests and specialized treatment whether or not they’re the best options.

“Physicians and the public don’t have good information about quality care,” said Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, which promotes health care improvements.

She advocated providing “evidence-based national guidelines for what works and what doesn’t.”

For instance, there’s evidence that giving a patient an antibiotic an hour before surgery reduces the chance of infection, while administering it either earlier or later is less effective. But that kind of standard is available “only for a fraction of the care we provide,” she told the Knight Center fellows last week.

Sen. Ron Wyden, an Oregon Democrat, said the climate is more receptive for adopting a national plan to revamp health insurance – many Republicans now recognize that fixing the system will require covering everyone, and more Democrats recognize that government can’t do it without involving private insurers.

He’s trying to sell his colleagues on S334, the Healthy Americans Act. It would, among other things, require all Americans to buy health insurance but make sure they can afford it.

Under the bill, employers would either turn premium subsidies into higher wages or contribute to a pool to help individuals or lower-income families buy insurance. Government would assist those below the poverty line. Insurance firms wouldn’t be able to cover only healthy people but could offer discounts to encourage healthful behavior.

On Dec. 7, Wyden and co-sponsor Bob Bennett, R-Utah, announced that they were up to a bipartisan 13 backers, including Republicans Trent Lott of Mississippi and Lamar Alexander of Tennessee, Democrat Debbie Stabenow of Michigan and independent Joe Lieberman of Connecticut.

“There’s a real chance that this may be the time the waters part,” Wyden said. But he’s realistic: “I never underestimate the capacity of the United States government to take something that’s doable and somehow unravel it all.”

Reinhardt said that Americans who most likely would benefit from “a progressively financed, universal health insurance scheme” either don’t vote or “vote for candidates promising them that one day they, too, will be billionaires, as long as they keep taxes and government spending low.”

If 2008 isn’t the time to stop following false logic, when will be?

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