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Wednesday, December 24, 2008

All I Want for Christmas Is Health Reform...

Kids say the darndest things...

While judging the U.S. Extemp final at the Bell Debate Tournament last Friday, I heard one student channel Sibby and cry socialism over Daschle's coming health reforms. She gave an impassioned speech, which usually wins points in my book, but she got so wrapped up in warning us of the Red Menace—something about how the free market and consumers have pulled us out of every previous economic valley and how Daschle now wants to throw rocks down at us—that she forgot to give any specifics of what kind of health reform Daschle and his boss plan to bring us.

We don't know yet what form the Daschle-Obama health plan will take, though I will continue to urge the incoming HHS Secretary to stop by Dennis Kucinich's office on his listening tour.

The one concrete point the young made in her extemp speech before rocketing off into Sibby-Silly Land was that Daschle might not be able to get any health reform done due to the burgeoning Bush deficit and the further economic stimulus Team Obama will have to implement to get us out of the recession. On that note, Howard Gleckman at the Tax Policy Center points out another key player in the Obama Administration who is focused on the cost side of health reform:

Can we do reform without worrying about cost? Serious analysts, including Jennings, Feder, and Rother, know we cannot. And so does Peter Orszag, who Obama will name to run OMB. Orszag, currently CBO director, has made cutting medical costs his crusade for the past couple of years.

In what will likely be an environment of mind-numbing deficits, health costs will matter more than ever. Reform cannot be just about covering the uninsured, which is relatively easy. It also means reducing the unnecessary and wasteful spending that Orszag says inflates the nation’s health care bill by one-third, or almost $700 billion annually [Howard Gleckman, "Will Recession Make Health Reform Easier for Obama?" Tax Vox, 2008.11.24].

What's that? I thought America's vaunted free market health system was all about efficiency. Silly me.

I've also heard opponents of socialized medicine fret that if the government paid for health care, everyone would rush to the hospital and overutilize medical resources.... because going to the hospital is so darn fun. Right. That's why we see rich people spending all their vacation time getting knee operations and chemotherapy.

Anyway, Gleckman suggests overutilization is actually a problem of America's private system:

Today, we grossly misallocate health care dollars. Some of us get far too many, others not nearly enough. In the end, slowing medical cost growth will mean rationing care in a more, um, rational way. It will mean that somebody—insurance companies, government, and ultimately doctors themselves—will have to tell patients that exercise and pain management may be more appropriate than back surgery, or that they may not get costly drugs that may extend their life by only a few months. Comparative effectiveness research that looks at the benefits of specific treatments is all the rage now. We are still a long way from turning this analysis into a real decision-making tool. However, the far bigger challenge will be convincing consumers to accept the consequences.

If we are going to have health reform, especially in the face of massive deficits, Obama’s most important job may be to get Americans to change the way they think about medical care. More, we must all learn, is not always better.

As Daschle has said, we already ration health care, and we do it in the least rational way possible, based on ability to pay. And that leads us to the paradoxical situation where we spend more and get less.

I hope the student I judged last weekend will recover from the lump-of-coal-like ballot I gave her and bulk up the health care folder in her extemp file. I also hope we can all carry some Christmas spirit over into the New Year, apply it to health reform, and bring some comfort and joy to our fellow man with a single-payer, not-for-profit national health coverage system.

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