Saturday, July 07, 2007

The Central Dilemma of Health Care Reform

The central dilemma of health care reform is this:

(a) the crisis arises from spending too much on health care.
(b) all of the political proposals for reform call for spending even more.

The usual rhetoric relating to the crisis in health care does not talk about expenditures, referring instead to high costs. But the only way to incur a cost is to spend money. So if costs are too high, then it follows that expenditures are too high.

Friend and erstwhile fellow Detroit parishioner Chuck Kleber was good enough to forward to me an article from the July 6 issue of The New York Times summarizing the positions of the various presidential candidates for the overhaul of the health care system.

The article suggests that the health care issue has to do mainly with the cost of care. However, most of the proposals being bruited about have to do with providing coverage for the uninsured. All of them in one way or another would increase spending and, therefore, cost. The only references to cost reduction were a proposal by Senator Hillary Clinton for a “Best Practices Institute” and the mention of reliance by both parties on better health information technology and disease management – neither of which, by itself, has to date shown much promise for cost reduction.

Everyone seems to have a pet explanation for the failure of the Clinton health care reform proposals of 1993-94. My own is that when push came to shove, there was no willingness to pay for them. The idea of pouring more money into an already overfunded system couldn’t be made to fly.

I suspect that continues to be the case and that the issue of health care reform will be with us for some time yet.

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