Morton Kondracke, a columnist for Roll Call newspaper, (sorry on-line subscription required to read the full article), had a very interesting and insightful piece yesterday where he outlines some of the reasons that health reform in 2009 will be more expansive than in might have been a few years ago.
He makes two very concrete and connected observations. First, that the economic downturn will increase the number of people without health insurance by 5-6 million, and probably add a similar number to the rolls for Medicaid and SCHIP – which will add to States’ budgetary problems. And second, that the costs of health reform are likely to be much greater than expected – assuming of course that there isn’t a dramatic economic rebound. The number he puts forward is “more than $3 trillion” over 10 years.
Higher costs are largely due to a greater number of people without health insurance, which would be consistent with the experience in Massachusetts: In Massachusetts the initial estimates of the number of uninsured were too low, and more people than projected enrolled in subsidized plans resulting in higher than expected costs. More people having health insurance is a good result from the perspective of moving towards universal coverage, (and for all the benefits it provides to individuals and society), but it is a bad result from the budgetary perspective.
How these expanding challenges are met in what is actually agreed to for health reform in the coming months, (for the legislation), and years, (for the regulation and implementation), will be important for both our individual and national health and finances. While it would be nice to say that it is important that health reform be done “right,” because so much of what will be done is new – either in substance or scope – that I think it is more realistic to hope that the specifics of health reform don’t include too many missteps or components that need to be significantly revised in the future to correct unexpected outcomes.
What do you think?
Another reason for the problems with the Massachusetts universal coverage initiative is that there are not enough primary care physicians in Massachusetts. Worse still, there are not enough primary care physicians in the United States. And half of those that are in practice plan to restrict their practice hours or leave medicine entirely in the next 3 years. And med students are not going into primary care.
We didn’t want to pay primary care physicians anywhere near what we were willing to pay specialists. That’s why Americans are being treated in emergency rooms instead of family doctor offices. That’s at least part of the reason we spend over $2 trillion a year on health care in this country.