The Health Care Morass

Posted by Joe Klein Monday, July 27, 2009 at 12:33 pm

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Washington, it is well known, was built on a swamp. In summer, it seems especially swampy. And it seems swampiest of all when it is locked in a major legislative struggle--and all of the above is going on right now. The amount of foolish, noxious complicated and misleading statements being tossed around right now (on all sides, by the way) seems to increase exponentially, by the day. Take this, today, from Robert J. Samuelson in the Washington Post:

The notion that the uninsured get little or no care is a myth: They now receive about 50 to 70 percent as much health care as the insured. If they become insured, they would use more health care, possibly as much as today's insured. That would increase both government and private health spending, depending on how the insurance is provided.

Except maybe not...because we simply don't know. The 50-70% coverage--I love the numbing, economic nincompoopery of that stat--that they get takes place mostly in emergency rooms, the most expensive health care delivery system imaginable. If those same people had regular primary care physicians, they could nip those emergencies in the bud through preventive care, especially the use of drugs. (Add: In his press conference last week...)The President used the familiar example of a diabetic who, absent preventive care, needs to have an amputation in his press conference last week. (Boy, do I need a vacation.)

In other words, the 30-50% of coverage that the uninsured are not getting might well lower the costs of the 50-70% of coverage that they are. But no one knows. That's one of the reasons why it is difficult for the Congressional Budget Office to "score" the cost of these bills.

No doubt, Samuelson has a point. Cover everyone and it costs more--but we don't know how much more, and it may cost less than we think. It will certainly cost less in the areas economists can't quantify, but which have very real economic impacts: in the level of panic and uncertainty that exists in the society, the opportunity cost in entrepreneurial energy among people who might start a new business but are locked into their jobs because they need their health benefits--and a thousand other, non-fiscal benefits.

One of my favorite Springsteen lyrics is, "We've got to start saving up for the things that money can't buy." That's the best argument for a health care system that costs less in anxiety and unfairness. In the end, a conversation about universal health care can't just be about money. It has to also be about values, about what sort of society we want to be--and need to be in an era of economic volatility and uncertainty.