Work to keep health care reform on track clearly is in a critical vise. Emboldened Senate Republicans, fortified by the addition of the new senator from Massachusetts, are relishing their restored 41-member, filibuster-strength power to thwart reform and make it a November election issue. Democrats, by contrast, are huddling in low-profile talks to find a way to reconcile their divergent Senate and House bills and push the final version out of the bottleneck created by Independent Joe Lieberman and onto the president’s desk.
In the meantime, more and more financially strapped Americans, suffering from the loss of jobs and health insurance, are turning to state Medicaid programs or indigent care for aid. That shift, discussed in the editorial below, is pushing recession-wrecked states’ operating and Medicaid budgets over the cliff.
The trend for Medicaid is particularly ominous. As described in a report by the federal Centers for Medicare and Medicaid Services, public funds accounted for 47 percent of the nation’s $2.34 trillion in health spending in 2008. But that proportion is expected to account for 50.4 percent of all national spending on health care in 2011, assuming Congress will act again to defer scheduled cuts in Medicare reimbursements to physicians.
The CMMS report estimates that total national health care spending rose to $2.5 trillion last year, up 5.7 percent over the previous year. That would push the nation’s total health care spending to 17.3 percent of the nation’s gross domestic product, up from 16.2 percent in 2008.
By 2019, the CMMS predicts that total national spending on health care will rise to 19.3 percent of GDP. In the same period, the Wall Street Journal’s David Wessel reports, the Urban Institute, in the best case of three scenarios, estimates the number of uninsured will rise from 49.1 million in 2009 to 57 million — most of them middle-income adults priced out of employer-based insurance, or victims of employers dropping unaffordable insurance plans.
These figures are mind-boggling, and scary for the nation’s direction on both the overall cost of health care, and the share of spending on health care that will come out of public dollars.
The nation simply cannot afford this trend, if for no other reason than to preserve our economic competitiveness. America’s out-of-control health care spending dwarfs the proportion of GDP spent on health in all other advanced countries, all of which have universal health care and far better public health indices. They accomplish this while spending generally from 8-to-11 percent of GDP on health care, or from $3,500 to $4,500 per capita, as compared to America’s $7,500 per capita.
The consequences of such distorted health care spending in America are dire. Nationally, government programs — chiefly Medicare, Medicaid and medical services for veterans — are now predicted to account for more than half of all U.S. health care spending next year, the Wall Street Journal reported last Thursday. Repeat: Next year.
This significant shift will occur not just because of the economic recession: It will occur mainly because of Republicans’ long-standing denial of the need to institute health care reform to enable the country to radically reduce health-care spending to the more sustainable levels enjoyed by all other advanced nations.
Republicans are so in thrall to the powerful lobbies of the medical and insurance industries that they refuse to contemplate the fiscal train wreck they are inflicting on the United States — even as they ignore the nation’s terrifying rates of medical bankruptcies and the staggering numbers of uninsured citizens who can’t get regular care.
With the demographic shift now occurring — remember, the post World War II baby boomer retirement wave will intensify dramatically next year — spending on both Social Security and Medicare will begin rising dramatically next year, along with recession-induced spending on Medicaid.
As White House budget director Peter Orszag cautioned last week, the out-year deficit spending trends –in 2020, 2030 and 2040 — are unsustainable. “If we don’t address rising health-care costs, there’s nothing else that we’re going to be able to do that will alter that basic fact,” he said.
How Republicans can overlook both the human and moral costs of their disdain for reform is mystifying — all the more so for the brutal irony of their immense fiscal misfeasance over the past eight years of deficit spending for tax cuts and wars that sucked the national economy into the current vortex of financial meltdown and deep and unyielding recession and joblessness.