Health Care One More Time
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Description
People on all sides of the political spectrum agree that the crazy-quilt of the American health-care system needs major revamping. The analysis typically revolves around three interrelated axes: access, cost, and quality. On access, the dominant concern is the forty-six million individuals who do not have health insurance, plus those who may lose their coverage if the current recession deepens. That figure is, however, subject to important refinements: about ten million of those who are uninsured have had to opt out of the market because of high prices; about twelve million are eligible for government programs in which they have not enrolled; about 4.1 million children are now eligible for inclusion in the expanded State Children’s Health Insurance Program (SCHIP); and another ten million are illegal immigrants. The remaining fourteen million represent less than 5 percent of the overall population. Any comprehensive health-care plan must at a minimum address each of these groups. On cost, health care now gobbles up an ever larger fraction of gross domestic product (GDP). Three numbers capture the overall picture. First, total health-care expenditures reached $2.4 trillion in 2007, almost 17 percent of GDP, or about $7,900 per person. The projections are for more of the same. One estimate has 17.6 percent of GDP going for health care in the year 2009 (see http://homecaremag.com/news/health-care-spending-exceed-gdp-growth-20090224). Another estimate finds that $4.3 trillion, or 20 percent of GDP, will be spent on health care as of 2017 (see www.nchc.org/facts/cost.shtml). Poorer countries have lower costs, broader health-care coverage, and longer life expectancies. What, if anything, would allow us to spend health-care dollars more efficiently than we do today? On quality, at its best American health-care is as good as or better than any other throughout the world. But U.S. quality standards are far from uniform, and the uneasy sense is that the insistent cost pressures on the system will erode health-care quality in ways hard to identify and harder to correct. How should we cut this Gordian knot? The first hundred days of the Obama term have yielded only hints as to its eventual approach because the going is necessarily slow. Health-care reform is more complex than labor market reform, which has generated a huge hubbub involving the (misnamed) Employee Free Choice Act, legislation that is only two pages long. No one can pack health-care reform into that small a nutshell. In addition, the Obama team lost momentum when former Senate majority leader Tom Daschle, a consummate insider, was forced to withdraw his nomination for secretary of health and human services, paving the way for former Kansas governor Kathleen Sebelius, who is not. As the Obama administration works feverishly to extend insurance coverage without upsetting established institutions, it is critical that we take stock of the full range of reform possibilities, including roads not taken. This chapter first examines the philosophical foundation behind the modern claims of the right to health care before turning to the two major policy initiatives that are now under consideration: the first is a single-payer health-care system based on the Canadian model; the second, more eclectic effort hopes to build on existing public and private programs to extend basic coverage. I support neither of these efforts. The simplest and most cogent objection is that they are too costly, as no government can successfully devise rules to constrain demand while seeking to drive to zero the health care costs of recipients. Accordingly, in the last section I present an alternative approach that stresses deregulation, which, by reining in health care, expands access to health-care services for those now excluded from the system.
Source Publication
Reacting to the Spending Spree: Policy Changes We Can Afford
Source Editors/Authors
Terry L. Anderson, Richard Sousa
Publication Date
2009
Recommended Citation
Epstein, Richard A., "Health Care One More Time" (2009). Faculty Chapters. 389.
https://gretchen.law.nyu.edu/fac-chapt/389
