Saturday, October 31, 2009

Two Writers

Throughout the health care finance debate, I've been impressed with Timothy Noah's articles. He covers both the economics of the issue and the political processes that decide policy. Today's column on the Congressional Budget Office evaluation of the House Democrats' health finance bill is about the best discussion yet. Noah clearly describes what "bending the cost curve"--that Holy Grail of this year's debate--means and what the CBO's numbers mean in that context.

Noah makes, as did the Association of Health Insurance Plans, an implicit case for a single, universal system, divorced from profit-seeking. That case is the profit-seekers' incentive to maximize profit and shed liabilities that reduce that profit. A public option that becomes the last resort for unprofitable, costly individuals may well cost a lot more than projected. Short of strictly limiting premiums and medical fees, for which the votes don't exist as Noah points out, the public option may be doomed even if it actually becomes law.

In contrast to Noah's commentary, which is the here and now of the current debate, , I am also reading T.R. Reid's The Healing of America. Reid is another writer who explains policy well. In this book Reid uses his injured shoulder as a template for exploring health care in other countries. I am only through France, Germany and Japan so far. One common thread is that these nations have essentially a single system for establishing medical fees and payments, a system that limits the income of health providers in those countries.

Reid's prologue tips his hand: he believes America can learn from the experiences of other nations. One of the ideas Reid describes is France's Le Carte Vitale. A plastic card with an embedded microchip, Le Carte Vitale, carries a person's complete medical history and serves as the basis for French medical billing and payment. Reid finds no record rooms and back office staff in the French medical clinics he visits. They are unnecessary. He notes that the French take a certain amount of pride in coming up with the Vital Card before America did.

Between Reid and Noah, I can safely predict that the health care finance bill that passes this year will not be the last. I can also hope that whatever jury-rigged, compromised and bartered system emerges from this year's debate will further demonstrate the inherent contradictions of a profit-driven health care finance. Maybe then we will seriously address the issue. The rest of the developed world has done so.



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