Healthcare reform doesn't have to be a federal trap
We can control costs without rationing care or making people buy insurance.
The controversial end-of-life counseling provision will probably be stripped from a final health reform bill. But even so, the broader tension between ever-rising healthcare costs and federal budget constraints – which inevitably leads to rationing – needs resolution, and soon.Skip to next paragraph
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We can resolve this tension without giving government even more control over our healthcare.
Claims that a "public" insurance plan (which itself may be dropped) would ration care and deny treatment aren't scare tactics – they're conclusions drawn from the record.
Take Medicare. It already denies seniors 1 of every 10 claims for service. What proportion will be rejected in eight years, when Medicare's hospital insurance trust fund assets are expected to be exhausted: 5 out of 10? Nine out of 10?
As healthcare costs outpace other areas of spending, the government will inevitably look for cuts. The Medicare program is already the largest single-payer health program in the world – accounting for $468 billion in 2008. And within Medicare, care in the last year of life accounts for about one-quarter of costs. If you were overseeing Medicare's budget, wouldn't you target those expenditures for cost control?
Given that Medicare is headed for bankruptcy, why would we take steps that would massively increase government's role in healthcare? Wouldn't this exacerbate the problem of denied care for seniors?
Socialism is appealing to some because things are paid for with someone else's money. But when it comes to government healthcare, having someone else pay means having someone else decide. In the leading health reform bill (H.R. 3200), a panel of up to 27 medical and other experts chaired by the Surgeon General will recommend (with public input) what benefits to cover. This concentrates a huge amount of decisionmaking power in very few hands.
Let's drop the push for nationalizing healthcare and instead provide strong tax incentives to encourage individuals and families to be responsible for choosing and owning health insurance coverage, while also maintaining a safety net for those who can't afford it. Tax law encourages most people to rely on employers for health insurance, thereby insulating consumers from costs. Yet, we don't rely on employers to purchase automobile insurance, life insurance, or homeowners insurance. And we aren't facing a national crisis regarding affordability for those insurance premiums.
If we are serious about reducing healthcare costs to help make services affordable and available to all, we need policies that create true competition in health insurance, and that encourage consumers to be cost conscious. Congress should level the playing field by allowing everyone to deduct the full costs of health insurance, regardless of whether they buy it on their own or receive it through an employer. A refundable tax credit could be provided for those with no tax liability.