If a tree falls in the forest: Health care diary

echoing the sentiments of other diarists such as in ssolice's "public health now dead on dkos", the topic of health care these days (agreed far less sexy than voter fraud and DNC chair politics) raises the question: if a diary is not read by anyone, is there really a diary message? However,  it is a powerful (if somewhat murky) current in many other issues as raised in bonddad's diary on "weekly economic wrap up". Therefore, I think it deserves regular, if largely unread mention.

An article with good brushstrokes on some of the issues in healthcare can be found in today's NYT.  It serves as much needed exposure about the real issues in health care that are not going to be solved by BushCo's Health Savings Accounts.

more below the fold.

The author of the NYT piece nicely outlines the problem  from the perspective of executives and investors rather than from one of public responsibility or compassion...but he's right, and it's worth reading was we wade into the framing wars.

Particularly he nails a key issue with "health savings accouts" that are being promoted as a panacea by the Bush admin. (For an explanation of why these aren't "savings accounts" at all, see my previous diary.)These health savings accounts will not bring down health care costs for you, me, or the government. They will simply shift costs around to burden the sick, probably the government further, and will put the average health citizen at risk for financial ruin in the event that her health luck changes unexpectedly toward catstrophic illness. Not to mention that they don't even address health care coverage for the poor and unemployed which comprise a significant amount of this country's high health care costs.

Here's a snippet from the article:

Some people have argued that advances in medical technology will eventually bail us out. Instead, those advances are likely to drive up costs by giving us more on which to spend, just as they have in the past. Other factors in this spending growth are the aging of the population, not to mention our national habit of overeating and underexercising. The impact will be amplified by the huge cost-shifting that characterizes our system. The cost of hospital care for the uninsured, for instance, is quietly built into hospital prices paid by the insured - who in turn pass along part of their costs to Uncle Sam (through tax deductions).

New tax-sheltered health savings accounts, coupled with high-deductible insurance policies, are supposed to help by letting people set aside their own money for the first few thousand dollars of medical bills each year. But don't expect miracles from these new plans. People with chronic ailments probably won't choose them, resulting mainly in a tax giveaway to the healthy, affluent Americans who will. Besides, as Martin S. Gaynor, an economist at Carnegie Mellon University, observes, relatively few Americans account for the bulk of all spending on health care. In one study, 10 percent of the people accounted for 69 percent of the cost. The implication is that helping most people to economize on routine medical expenses probably won't help much.

The short-term impact of rising health care costs is cushioned by the tax breaks that come with medical coverage. Health insurance benefits are attractive to both employers and workers because they save both parties money, compared with an equivalent amount of regular wages. But by picking up part of the bill, the government is merely passing the buck to other taxpayers - and masking the costs, while encouraging higher medical spending.

Furthermore, buried here in the business section is a nice plug for a national health care system (dare i say: universal coverage?)

Eliminating the tax deduction for traditional health coverage is the first step out of this morass. One advocate of such a move is Martin S. Feldstein, the Harvard economics professor and president of the National Bureau of Economic Research, who says it would increase federal income tax collections by $120 billion a year. In my view, businesses should stop providing health insurance altogether. It's a crazy, inefficient system that limits labor mobility and puts American firms at a big disadvantage. The $1,400 a car that General Motors spends on health care is one reason that Ontario, which has government health insurance, may soon surpass Michigan in automobile manufacturing.

BEYOND that, it's time for business to mobilize its army of lobbyists for a national system of coverage that is comprehensive and competitive, and contains strong incentives not to spend. Like car insurance, it has to be mandatory - for the healthy as well as the sick - but left to individuals to buy. Through tax credits or other means, the government can provide it for those who can't afford it. We will also need a big national campaign to discourage unhealthy styles of living, which account for so much medical expenditure. And we will need coordinated deployment of information technology to find out what kinds of medical spending are worthwhile and what kinds aren't.

Now, he packs a lot of big projects into this last paragraph...but we need to brush up on how we can influence some of these things on his to-do list. We can start by reframing Bush's health care plan, as "Sickness denial plan" or the "Sweep the healthcare problem under the rug plan." For fact based ammo on what these plans are all about see this reference: Pauly, Mark V, Goodman, John C. Health Affairs.  Spring 1995.Vol.14, Iss. 1;  pg. 126. (sorry, link is subscription only.) This article is written by a guy on Bush's health care "reform" planning team (Goodman).

We need to participate in this conversation about health care costs and "health savings accounts" because, it is a potential progressive "strategic initiative" (from Lakoff.) It can affect not only a drive toward universal coverage (great analogy in the NYT article to car insurance), but also environmental issues (parks and outdoor spaces to exercise for health improvement), policies about nutrition in schools, and on and on. Being healthy is an issue that can invoke the "nurturer" in even the reddest of conservative dimwits (especially women as primary decision makers of family health care choices.)

•  anyone been offered an "HSA"

  by the way has anyone had a good/bad experience with a "health savings account".  i would be interested in hearing what real world experiences with these have been.

  by throwlikeagirl on Sun Dec 12, 2004 at 07:04:48 AM PDT

  •  HSA is like insurance

    My experience with a health savings account was very negative. "Savings account" is a misnomer. Once your money goes in, it's not your money anymore. It belongs to the insurance company administering it, and in order to get any money out, you must prove your expenses to the satisfaction of the insurance company. That means providing receipts for everything, and being subject to whatever limitations they've written into your coverage, just as when you're applying for insurance payouts. I found I was unable to get back what I expected to get back, and the hassle it involved wasn't worth the tax savings.

    by lesliet on Sun Dec 12, 2004 at 07:23:03 AM PDT

    •  not savings accts for other reason

      Yes, i figured that they were a tremendous hassle to figure out for some users.

      they are also not savings acct because under the bush plan, a user is able to withdraw unused money at the end of the yr with no requirment that it be used for health care. poor people will have a greater need for the cash and thus are likely to forego needed preventative and routine health services in hope of cashing out on these at the end of the year.

      by throwlikeagirl on Sun Dec 12, 2004 at 07:35:41 AM PDT

•  It strikes me

  that many businesses (as well as many physicians) are coming to see that single-payer universal health care system is the way to go.  That's two of the three largest lobbies that were against such a system in the past.  The big hurdle, of course, is the insurance lobby.

  by a gilas girl on Sun Dec 12, 2004 at 07:40:17 AM PDT

•  Why is it so hard to admit Canada got it right?

  The only real problem with our system is we're not as rich as you. If we had the money to spend on health care per capita that the US government spends now, our way would be darn near perfect.

  The author of the article comes so close, and then gets scared. It's funny. "Like car insurance, it has to be mandatory - for the healthy as well as the sick..."

  ...so close, so close! but then he realizes he's veering perilously near (gasp!) socialism! and scurries quickly away:

  " - but left to individuals to buy."

  But then he realizes that there's a problem. What about all the people who won't have the money? Oops. That won't work. He has a classic solution, though:

  "Through tax credits or other means, the government can provide it for those who can't afford it."

  If they're unable to afford even the lower-cost health insurance he's talking about, a tax credit isn't going to do them much good. Not unless the tax "credit" will pay money to the people who don't have taxable income -- and that's even more socialist! Anyway, if you're going to do that, why not have the government pay for the insurance directly and save all the bureaucratic overhead?

  Of course, then you have to wonder why the government is only supposed to pay for really poor people and not others. Isn't that Medicaid? Don't you have it already? Except it's really hard to get on the list, and the process of qualifying is offensive to human dignity. If government-paid medical care is more efficient -- and it is -- why not do it that way for everyone?

  Analyze what he's proposing, and you see the net effect is to take the burden of health care away from employers and put the whole weight on citizens with some level of income -- otherwise known as employees. Oh, and by the way, make it compulsory. What is he planning to do about people who don't buy it, throw them in debtors' prison? (But don't, whatever you do, shove the health insurance companies away from the trough. Their profits are sacrosanct.)

  Sheesh.

  That isn't going to work.

  Maybe that's why he tossed in the cover phrase, "or other means."

  by Canadian Reader on Sun Dec 12, 2004 at 08:57:18 AM PDT

  •  i agree that he plays chicken

    with real problem solving. but at least he actually introduced the idea of a national health plan into a BUSINESS section...it's better than the progressive/democratic side has managed. (i don't know this guy's affiliation.)

    at least he got the issue on the table.
    i agree that he veered and swerved with some of the "tax credits" bs. (that is what my other diary was about.)

    by throwlikeagirl on Sun Dec 12, 2004 at 09:00:41 AM PDT