The illusory promise of free-market health care miracles

[marmar]

September 8th, 2012 11:48 AM

The illusory promise of free-market health care miracles
Republican rhetoric aside, the answers lie elsewhere

By Wendell Potter


While listening to the promises to repeal ObamaCare during the Republican National Convention, I was reminded of what those of us in the health insurance industry said when our friends in Congress were able to block passage of President Clinton’s health care reform legislation 18 years ago.

Like the politicians in Tampa, we insisted then that a big government program not only wasn’t needed, but would be harmful — that what the government really needed to do was get out of the way and let the free market work.

Insurance company spokesmen like me assured the public that our then-novel managed care plans, coupled with the invisible hand of the market, would do the trick. Leave it to us, we said, and we’ll get medical costs under control and enroll every American in a good HMO.

The proponents of a pure free-market health care system hope that Americans have amnesia and can be persuaded to blame President Obama for the problems that grew almost immeasurably worse between the demise of the Clinton plan and the passage of the Affordable Care Act. They want us to believe, despite overwhelming evidence to the contrary, that health insurers and the largely unfettered, loosely regulated marketplace can somehow turn things around. And that we should reward insurers for their failure by turning the Medicare program over to them. ..................(more)

The complete piece is at: http://www.michaelmoore.com/words/mike-friends-blog/illusory-promise-free-market-health-care-miracles

[dkf]

1. Health care is too complicated and opaque to figure out what a good decision is.

[Puzzler]

2. "Heath Care" does not mean "Health Insurance"

Or at least it shouldn't. The framing of the debate always seems to get muddied, IMO.

[Igel]

3. Controlling costs isn't the same thing as controlling prices, either.

If you don't have that kind of muddle you tend to stand and stare in slack-jawed indecision.

But my favorite conundrum is this: When an employer says he's going to control costs, pretty much every worker knows what that means. It's not going to be pretty.

But when we say we're going to cut health care costs, we really have few clues. We talk about insurance bureaucracy, but wouldn't like having 10k people unemployed when we reduce bureaucracy. We talk about reducing profits, but then pensions and IRAs don't benefit from the anticipated dividends or capital gains. We talk about liking employees, but a lot of cost reduction hinges on reducing payroll costs for doctors and nurses. We talk about liking manufacturing, but a lot of cost reduction is going to mean not having fancy big-ticket equipment, much of which is domestically produced and purchased. What we really don't like is the huge CEO benefits packages, which actually go to few people and largely consist of stocks and future income/earnings. Divvy those huge benefits packages up over all those insured, and each year you can get a Big Mac value meal supersized (except in NYC) and perhaps an apple pie or a milkshake. They're not easily defensible, but mostly function like red waving flags in front of bulls. We get enraged and charge about something that ultimately isn't far above trivial without really thinking.

In the end, when an employer says they're cutting costs, we cringe because it means we take in less money. When we talk about cutting health care costs, we rejoice because it means we spend less money. We each sound very much like miniscule corporations, each maximizing income and minimizing expenses. Instead of corporate personhood, it's personal corporatehood.

In the end, after we've dithered around the edges and patted ourselves on our back we have to make hard choices. We talk about the 99% vs 1%. In health expenses it's more like the 90% versus the 10%. If we don't have price-based rationing, we need another kind of rationing--otherwise we'll see health care expenses soar.