Health Affairs Blog
http://healthaffairs.org/blog/2011/09/14/census-numbers-the-trend-toward-government-coverage-continues/Census Numbers: The Trend Toward Government Coverage ContinuesIn its yearly survey of health insurance coverage, the U.S. Census Bureau published figures that underscore the trend toward greater dependence on government for coverage.
Those on the right (including myself) who oppose the government-based model see an alternative path toward portability and continuity based on individual ownership and market-based competition. The Heritage Foundation's Saving the American Dream plan empowers individuals and families to own and control their health insurance. It establishes individual tax relief for people to buy coverage in a marketplace where insurers and providers are accountable to meeting consumers? needs of higher quality at lower costs. It also reforms Medicare and Medicaid, putting them on a sustainable path forward.
While discussion of the Census numbers typically focuses on changes affecting the uninsured, the real story is the slow but steady trend away from private coverage and toward government coverage. Recent estimates by the CMS actuaries project that by 2020, government will control 50 percent of all health care spending in the country. Americans should take note that the health care system is moving to the tipping point where it will be more government-run than private.
Response by Don McCanne of PNHP
Why would health care be fiscally unsustainable when it is paid for through a government program, yet sustainable when it is paid for privately?
The fiscally unsustainable argument is based on the assumptions that the government would not introduce adequate cost containment measures, and that the government would not impose adequate taxes or tax equivalents to pay for the system. Based on the experience of other nations, both assumptions should be challenged.
Other nations use either government ownership or robust government regulation to slow the growth in health care costs. They also use government taxing authority or regulatory mandates to ensure that the health system is fiscally sustainable. Directly or indirectly, they function as a public monopsony. Although they may complain about their own rising costs, they certainly spend less money than we do, yet they are able to include essentially everyone in their comprehensive programs.
How would private control of health spending produce a fiscally sustainable system? The answer is that it would be fiscally sustainable only for the government. With a median household income of $49,000 and average health care expenditures of an insured family at $18,000 (Milliman Medical Index), health care costs for individuals and families are already unsustainable. (Median households and families with employer-sponsored plans are not the same, but these numbers still illustrate the enormity of the problem.)
Health consumer empowerment is being achieved by shifting more of the responsibility for payment directly to patients, especially through increased deductibles and other cost sharing. At today's high heath care costs that means that many more patients would be foregoing beneficial health care services, simply because they can't pay for them.
Now Medicare and Medicaid are being threatened with proposed reforms that allegedly would put them on the path of sustainability. Again, that might be sustainable for the government, but the proposed changes would shift more costs to patients, further impairing access because of increasing financial
barriers to care.
Many of us were shocked recently during the Republican candidates' debate when the moderator asked if a thirty year old, critically ill man should be allowed to die because he was uninsured, and members of the audience shouted, "Yes." But that was only a very few voices from an anti-government Tea Party audience. Not only would citizens of other nations emphatically reject this view, it also decidedly violates American values.
Nina Owcharenko offers us the choice between consumer empowerment in which we can reject the health care we need but can't pay for, or our own beneficent government monopsony that would ensure value in our health care purchasing so that all of us could have the health care that we need.
Although her blog entry and this response may appear to be merely a rhetorical game, the choice really is a matter of our nation?s health.
My comment: Word for the day = monosopy. It is like a monopoly, except that in a monopoly the market is dominated by a single
seller, and in a monosopy the market is dominated by a single
buyer. And you make private health insurance "sustainable" by bankrupting and/or killing the sickest 5% that account for 50% of health care costs.
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