Harsh right-wing opponents of national health care reform continue to chant their deceptive mantra that the House and Senate reform bills would cost $1 trillion dollars — but always without saying what health care will cost will be higher if we don’t enact reform.
The truth about the cost of the Senate bill, scored by the nonpartisan Congressional Budget Office at $871 billion (not $1 trillion) over 10 years, is that it actually would reduce federal deficit spending on health care — by $132 billion, according to the CBO — that would otherwise occur if no reform takes place.
In other words, reform legislation is crafted to pay for itself, plus leave a bonus — unlike the $4 trillion in 2001 and 2003 Bush tax cuts that (speaking of deficits) were not paid for, and that gave the lion’s share of benefits to the wealthy.
In addition, health care reform would provide coverage for 31 million Americans who are now uninsured; help working families buy better policies; and establish fairer rules and floors on insurance companies’ policies that every American family will gladly welcome.
Reform lowers federal deficit
Opponents of reform regularly make deceitful claims about the projected costs of reform and its benefits, but they do so with scant regard for the facts or for their integrity. Realistically, new CBO budget projections show that national spending on health care will double from the 2008 figure of $2.3 trillion (16.2 percent of gross domestic product), to around $4.5 trillion (or 20-plus percent of GDP) in the next 10 years. The federal government’s share of that spending — $817 billion in 2008 on Medicare, Medicaid and federal employees and veterans — would rise proportionally.
Given this increase in total federal health-care spending as baby boomers’ retirements mount, reducing the federal government’s health care spending and overhauling the health care play-book are absolutely vital to the nation’s capacity to sustain Medicare, Medicare and veterans’ care.
A more rational path
Reform is just as vital to help private businesses and individual citizens control their health spending. Yet cutting such spending will be virtually impossible without health care reform and more efficient spending.
Thus critics, who routinely chant that we can’t afford reform because we’re already spending too much on health care, actually have the equation backwards. It should be, we can not afford not to have reform. We simply cannot maintain the cost-spiral of the unrestrained status quo.
On an actual cost basis, conservatives should be the logical advocates of reform to reduce federal health care spending. It would also bend the cost curve on the $290 billion that state governments presently spend on health care, and the nearly $1 trillion in private sector spending.
Alas, cost efficiency and humane reductions in the staggering number of 48 million Americans forced to go without health insurance are not on conservatives’ agenda. They are fighting reform fiercely for two reasons: One, to deny the Obama administration and congressional Democrats anything that can be seen as a major political or policy victory. Secondly, because the lock-step Republicans who voted unanimously against reform rely heavily on their symbiotic linkage with the pharmaceutical and health insurance industries, which are spending heavily on campaign contributions to industry-friendly supporters to kill reform.
The medical industry (though not the physicians of the American Medical Association) is largely against reform because it knows it would wind down out-of-control spending and related profit-gouging tactics. New CBO figures confirm the extent of potential savings.
Its most recent report, the CBO put actual per-person costs to the gap cited previously on this page, in percentages, between the 16.2 percent of GDP that America spends on health care versus the 8.5-to-11 percent of GDP that other industrialized countries, all with universal and excellent health care systems, spend on health care.
Spending out of control
In per-capita spending, America spends about $7,681 on health care per-person. Counting federal ($817 billion) and state ($290 billion) health care spending and the $250 billion in lost revenue on the tax exclusion (a federal subsidy) for employer-provided insurance, America’s public health care spending comes to about $1.35 trillion (in 2008 costs), or just over $4,500 per person. Private sector spending, in addition, adds another $3,100 per-person to the nation’s health care spending, bringing the total to over $7,600 per-person.
By contrast, other advanced industrial nations with quality, comprehensive universal care spend less, in total, than $4,500 on health care per person. Total spending per-person in Germany, Canada and Belgium is about $4,000; in Australia and Britain, about $3,500 per-person. Japan spends even less. That’s a vast cost differential.
Better models abound
Other advanced countries achieve such greater efficiencies, plus better national health care indices for their citizens, chiefly in two ways: Partly through more efficient single-payer systems, but also by connecting costs more to comprehensive, universal care than to stacking fee-for-service procedures. And somehow they manage also to have more hospital beds and more doctors per 1,000 population than we have.
Americans, meanwhile, spend more on needless procedures, uncoordinated care for multiple problems, and far too much hospital and emergency room care for patients with acute and chronic conditions who could have been better treated, and treated less expensively, at an earlier stage with universal care aimed a prevention and coordinated case management. This shifted costs for indigent care amounts to about $1,000 of our $7,681 in annual per- person health care cost.
Many American doctors reasonably advocate putting universal-care concepts to work, as well as putting needed rules on insurance and pharmaceutical companies. The issue that remains to be addressed is why partisan politics, and gross disinformation, makes that so difficult to achieve.