National Journal Online -- Health Care Experts -- Paying (Or Not) For Reform

National Journal Online -- Health Care Experts -- Paying (Or Not) For Reform - Uwe Reinhardt Response:

It didn't take long before one of several howitzers got dug in to shoot at the idea of universal health insurance. The one out now is the familiar 'we need to control health care costs in our bloated, inefficient health system first before we can bring yet other Americans under the umbrella of health insurance and into the system.' That cannon has served us well for over three decades now. I can imagine its roar already, even before the cannon is fully cocked.

To shoot this cannon, you must have a license, and the requirement for that license is that you must be well insured and, indeed, be one of the folks who have helped bloat the system and made in inefficient. And because we, the well insured bloaters, have come to love that system so, we’ll do everything in our power not to change the status quo, won't we?

The other cannon, still being readied, is the 'crowd out' or 'crowd in' cannon. It gets deployed whenever someone in Congress or in the White House identifies the year's 'objects of compassion' (OCs). For example, the OC's may be uninsured children, or unemployed adults over 50, or whatever. The compassionate originator of the idea to do something for the OCs may calculate that it will take, say, $2,700 per OC to practice compassion upon them. No sooner uttered than the computers at the AEI or NBER or RAND or wherever start to whirr, figuring out how many OC-look-alikes now privately insured will be crowded into the new public program intended mainly for the original OCs. And before you know it, the federal budget cost calculated as (federal cost per original OC plus federal cost per crowded in OC) divided per original OC is staggering. Bullet hits on the mark, OC plan is destroyed. Mission accomplished.

This is how America has always successfully warded off any impending threat of universal coverage. Maybe it'll work again this time.

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