It has a fighting chance of improving on the status quo, which suggestsjust how bad the status quo is.
Herbert Stein, a White House economic adviser in the 1970s, liked to say that if something cannot go on forever, it will stop.
The country may have reached its Herb Stein moment in regard to healthcare. No, the spiraling growth in medical spending shows no sign ofslowing down, let alone stopping. But the wrangling over President Barack Obama’s plan to extend health coverage is having the salutary effect of educating America about Stein’s law.
The moon is not made of cheese. There is no pot of gold over therainbow. Medical spending, which already hoovers up one dollar of everysix that we make, cannot keep growing until everybody has a personaldoctor who works for nobody else.
Prediction: Obama’s proposal will end up as some kind of law by the endof the year. But no, it won’t eliminate wasteful care. It won’t extendcoverage to everybody. It will increase the budget deficit. That said,it has a fighting chance of improving on the status quo, which suggestsjust how bad the status quo is.But even if the legislation crashes and produces nothing more than ateachable moment about resources, scarcity and the impossibility ofgetting everything you wish for, it will have done some good.Thursday’s decision by Democratic leaders to delay a final vote onhealth care until the fall reflects how much is at stake and howbotched the process has been so far.
“So let me be clear: If we do not control these costs, we will not beable to control our deficit,” he said at his Wednesday night newsconference. “If we do not reform health care, your premiums andout-of-pocket costs will continue to skyrocket.”
But before this week he let the House of Representatives advance a billwith virtually no cost-control measures. The promises from the drug andhospital industries to cut billions in costs are meaningless withoutsome sort of federal monitor and I don’t mean Congress to make sureit happens.
Nor do Obama and Congress want to tax health-insurance benefits, whichare now exempt. Taxing medical plans would not only accomplish thecritical task of raising revenue to pay for expanded coverage; it wouldencourage cost control by removing a subsidy that disguises the truerelative expense of health care.
Likewise, the plans so far contain no statutory limit that would cutoff spending if growth got wild. They don’t put enough emphasis onwellness and prevention, either. And there is no “public” plan thatwould compete with private insurers and give a new job to theWoodlawn-based Centers for Medicare and Medicaid Services.