As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Monday, January 12, 2009

Limits Of The Imagination

There was a fairly amazing article in yesterday's Washington Post that I think hits on many of the features of this newfound effort to worry about the deficit and entitlements precisely at the moment when a Democratic President enters office facing a huge crisis requiring major public spending. The basic thrust of the story by David Brown, a doctor and science reporter, is that health care spending will inevitably expand forever, and there's nothing we can do to control costs, and pretty soon we're going to face a crossroads between wanting to live longer and healthier lives and being able to afford it. This was not in the opinion section.

This difficult truth, which has emerged over the past half-century, is leading the United States and the rest of the industrialized world into a new era of humankind [...]

Last year, 16 percent of the nation's gross domestic product went for health care, about $7,600 per person. In terms of human effort, health care is the new food. By 2016, when it reaches 20 percent of GDP, it will be the new shelter. If it grows at its present rate through the first three-quarters of this century, it will consume 38 percent of GDP by 2075. It will then be the new food and shelter.

This isn't a mistake. If it were, we might have a chance of stopping it. It's success -- the way things are supposed to be, and the way we want them to be.

"At the end of the day, when it comes to controlling health care costs, the enemy is us," said Drew Altman, head of the Henry J. Kaiser Family Foundation. "Americans want the latest and best in health care technology, and we want it down the street, and we want it now."

It sounds so simple, doesn't it? Americans greedily want to be healthy, and they demand the latest and greatest, and the costs skyrocket.

Now, nowhere in this analysis is any explanation of the method of delivery of the US health care system, and how its inefficiency may just be, I don't know, the source of the problem. I'm trying to remember when I barged into a doctor's office and insisted on an artificial heart because the guy down the street just got one. No, what happens is that I pay thousands of dollars in premiums to a for-profit insurer, and when I try to use my coverage, I barter with some customer service rep for hours on end trying to get them to sign off, and she gets paid along with a whole staff to keep treatment costs down, and her salary and the salary of the marketing team at the insurance company and the PR guys and the pharmaceutical reps bringing in free lunches for the doctors and the CEO's private jet all fall under that big number of "health care spending."

Also, health care spending grew at its lowest rate in a decade last year, mainly because the economy started slowing down, people started using CHEAPER generic drugs (I thought Americans wanted the best and they wanted it now?), and because of lower rates of growth for administrative costs in - wait for it - Medicare, the public not-for-profit alternative health care delivery system.

Now, it would be simply gauche to point out that the current health care delivery system sucks up all kinds of money for insurance industry profits and admin costs, and that the high cost of premiums force 47 million people to go without health care and use emergency rooms as their personal physician, jacking up costs prohibitively. That couldn't possibly explain all that growth in spending.

Except consider the current series of health care bills before Congress, and recognize that the plan which would cover the most uninsured and the plan which save the most money are THE SAME PLAN. Matt Yglesias has the charts to prove it, from this Commonwealth Fund report. As Yglesias notes, because that DFH Pete Stark wrote the bill that combines reducing the most uninsured with saving the most money, it's deeply unserious and outside the boundaries of conventional Beltway debate.

Stark’s is the best again. And yet there’s no chance whatsoever that we’ll actually do this because his plan, though the most practical, is also the most left-wing. Far too left-wing for the United States of America

Some folks, of course, will oppose the Stark plan because they’re right-wingers who don’t want to expand health care coverage. And some folks, will want to focus their energies on other, worse, plans because those plans have a better chance of passing. But what’s incredibly frustrating is that a lot of people who claim to want to change public policy to expand health care coverage and better control health care costs will nonetheless fail to embrace Stark’s plan or anything similar for no real reason other than ideological posturing. It just can’t be the case, as a matter of centrist dogma, that the best solution is actually the most left-wing solution. It’s a far more ideological stance than anything you’ll ever hear from Pete Stark or from me. But the people hewing to it will insist on being called pragmatists.

Pragmatists like David Brown, who says that we're all going to have to live with the costs of better medical care and drugs, and if it costs too much to save someone's life, well we just have to grapple with that Malthusian Spectre. It can't possibly be that bringing America's health care costs in line with every other industrialized nation on the planet would both help to fix the deficit and entitlement concerns AND deliver better quality and more affordable health care to every American.

That just cannot be. If it's such a good idea, why wouldn't we have thought of it by now?

This all reflects a very ideological problem, where the case for liberal government has either not been made or drowned out by the right for the past 40 years, and so the Very Serious People in Washington view that case as a pollyanna scenario. And in the exchange, we all suffer.

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