Thursday, December 04, 2008

Join The Discussion: Health Care

Tom Daschle and Lauren Aronson want your comments on health care:

This video summarizes a few of the ideas people have proposed: focusing more on prevention, setting up a Health Corps (like the Peace Corps) for recent graduates of the health care profession and focusing on cost-containment and how to provide health insurance for part-timers.

I don't want to throw cold water on these plans but I will. First, prevention is wonderful, assuming that it works (not all types of prevention have ever been tested), but it will not necessarily lower health care costs. This is because some illnesses still kill people rather fast whereas people who live very long lives tend to end up in expensive nursing homes. This does not mean that prevention wouldn't be something well worth supporting for the reason that it postpones pain and suffering (when effective). But it's not without some unexpected cost consequences.

Second, we have already experimented with Health Corps, in the form of grants to physicians for medical school which they had to pay back by working in under-served areas (rural areas and poor inner city areas). These worked in the sense of providing medical personnel for those areas, though the medical personnel was outa there the minute the debt was paid back. Not the ideal form of getting continuous care to the under-served areas, but better than nothing. If the Health Corps concept is supposed to be based on pure volunteerism without anything like money for medical school it will not work. The reason is that graduates have very high debts that they have to pay back fast.

Third, focusing on cost-containment is much easier said than done. Indeed, if you know how to contain health care costs while also never denying anyone treatment for anything they might want and while offering people in the field very nice salaries indeed, please tell us right now. If anything, the comments I read below the linked post (only the first hundred or so) suggest that what people want is health insurance and then nobody rationing their care at all. It's not possible to have a low-cost system without some form of rationing. Currently we do the rationing by prices and incomes, but if those are not used then something else will have to take their place.

Fourth, the idea of giving part-timers some way of getting health insurance is fantastic. It would help people whose jobs consist of two or three part-time jobs and it would help women who are working part-time because of family obligations, say. Of course the easiest way to do this would be to delink employment from health insurance. If that turns out to be politically unfeasible the problem is how to provide part-timers the benefits without making them such expensive employees that firms will no longer employ them.

That sounds quite curmudgeony, but I do that on purpose, because it's important to address all aspects of the proposed policies, including their negative aspects.