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Wednesday, September 23, 2009

No Health Care Reform Yet

I can’t be the only one who has noticed that what was once called health care reform and referred to often as overhaul of the health care system, is coming with some frequency to be referred to as health insurance reform, occasionally even by the White House.

It only goes to show how intractable our health care crisis really is. The core problem is that health care costs too much – significantly more than in many countries which spend much less on it than we do and are generally satisfied with what they get.

But the roots of that problem run deep – both historically and culturally – and are not well understood. And while it is popular to talk about how the system is “broken,” the reality is that most people are happy with the care they personally are getting They might like for somebody else to pay a larger share of the cost, but they don’t want the care itself, and the way it is provided, to be tinkered with. Evidence of that is found in President Obama’s frequent assurance that the only effect of his reform proposals on veterans, Medicare beneficiaries, and people satisfied with their health insurance will be to improve their coverage.

At the beginning of the current effort there was a lot of talk about cost and its threat to the financial well-being of individuals, corporations, and governments. But as the situation has developed, one hears less about that and more about providing coverage for the uninsured and improving coverage for everyone else – the effect of which will be to further accelerate increases in the cost of health care. Such reference to cost as there is tends to be pointed at health insurance companies despite that many of the insurance reforms proposed will increase health insurance premiums while making it more difficult for insurance companies to restrain rising costs.

The unpleasant fact is that the cost of health insurance is determined mainly by payments to doctors, hospitals, and other providers of health services, all of which are too expensive. Those providers need to find better and less costly ways of doing what they do, but that means change and change is unpopular.

So however the current so-called health care reform effort comes out, it seems that when it is all over, the need to reform our health care system will still be with us – perhaps even greater than before.

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