Hogan's Alley

Tuesday, July 20, 2010

Trouble On The Horizon For Medical "Reform"

"House Speaker Nancy Pelosi is “the mother of health care,” Vice President Joe Biden proclaimed Monday", according to the Washington Post.

 Well, that sort of bravado will no doubt play well on the Democratic chicken dinner circuit.  But sooner or later the realities of the new "Obamacare" legislation will be obvious.  Mostly the chickens will come home to roost by about 2014, well after the next presidential elections.  Until then, those who crafted this budget busting legislation will have to hope that a stiff upper lip will help them survive the next electoral round, which, after all, is the most any of them, regardless of party, ever contemplate.

In a very prescient piece in the Washington Post, Robert Samuelson reports on the findings of an Urban Institute study of the outcomes of the Massachusetts health reform effort, which looks very much like the stew crafted (as in witch crafted) by the President and the Democrats in Congress.

Read it and weep:

People have more access to treatment, though changes are small. In 2006, 87 percent of the non-elderly had a "usual source of care," presumably a doctor or clinic, Long and Stockley note in the journal Health Affairs. By 2009, that was 89.9 percent. In 2006, 70.9 percent received "preventive care"; in 2009, that was 77.7 percent. Out-of-pocket costs were less burdensome.

But much didn't change. Emergency rooms remain as crowded as ever; about a third of the non-elderly go at least once a year, and half their visits involve "non-emergency conditions." As for improvements in health, most probably lie in the future. "Many of the uninsured were young and healthy," writes Long. Their "expected gains in health status" would be mostly long-term. Finally -- and most important -- health costs continue to soar.

Yes, some of the young and healthy who have traditionally been uninsured will possibly seek medical attention that will uncover chronic diseases like hypertension and diabetes.  But will the numbers who avail themselves of this newly available care be so tiny as to have virtually no financial impact on their need for care later in life?  Look at the example of those who use emergency rooms for a form of primary care.  Many of them had Medicaid before yet continued the habits and inclinations of a lifetime.  People tend to act in their own self interest, not in what may in fact be the rational manner viewed as obvious by academics.  They do what offers them the percieved path of least resistance.  This is one of the major realities that will prevent  the anticipated savings from accruing as predicted.

Nor did anyone in the recent debates over medical reform even raise the problem of fee for service medicine.  It is as hot a potato as cutting Medicare benefits for seniors.  It will never happen in the 2 - 4 year life cycles of our politicians.   At least not till we are all staring  over the edge of a massive debt crisis that forces painful cuts and tax increases.

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