Wednesday, September 30, 2009

Does Cost Need a Crisis?

Public support for the Massachusetts health care reform program is slipping and concerns about the cost of health care are growing. Those are the results of a survey reported in the September 28 issue of The Boston Globe. During the past year the approval rate for the program dropped from 69 per cent down to 59 per cent. So a substantial majority still approves. But 43 per cent believe that the state cannot afford to continue with the health insurance law as it now stands.

There are three main issues in health care reform: quality, cost, and coverage. Most of the public attention is being focused on cost and coverage,

There is a question of whether cost and coverage should be dealt with together or separately and, if separately, which should be addressed first. Considering that expanding coverage will increase cost, it would seem that the cost issue should take priority.

The logic of the subject matter may point that way, but the logic of politics may not. Commenting in the Globe article, Drew Altman, president of the Kaiser Family Foundation was quoted as saying “The fact that Massachusetts led with coverage and then turned aggressively to cost control will do more for costs in the next five years than national legislation will do in ten….because in Massachusetts, you are staring a real affordability issue in the face.”

Altman seems to believe that the way to get the public serious about cost is to create a financial crisis of affordability.

He may be correct. The evidence seems to be on his side. Double digit annual percentage increases in cost leading up to an economy in which health care represents one dollar out of seven has not elicited any significant public response up to now. So maybe what has to happen is enactment of a health care coverage plan that we can’t afford. Then when the inevitable cutbacks become necessary, the pain of doing it may prove great enough to make cost control an acceptable alternative.

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