It is always painful to see people try to give the left helpful advice on how to solve a problem when they clearly know nothing about it. The most recent example is former New York Times editor, Bill Keller, who after first telling boomers they should lead in the fight to undermine America’s already very spartan social safety net for seniors, is now offering absurdly ignorant advice on health care spending and how it impacts the debt.
First Keller promotes the zombie myth that “skin in the game” is good for controlling health costs. From Keller:
As I’ve said before, in defending Obamacare, I think it’s too risky to expect ordinary consumers – busy, stressed, fearful, unschooled in the vagaries of markets – to be expert stewards of the investments on which their old-age security depends, or to be shrewd judges of competing health plans. They should have SOME skin in the game, but the Republican plans leave them bare naked. And the Republicans do not seem inclined to direct any of their anticipated savings into investment.
Why Keller thinks USING ALL CAPS will magically add validity to the argument is beyond me.
In reality, looking around the world there is no reason to think “SOME skin in the game” will have a significant effect in controlling health care costs. By “SOME skin,” Keller must mean more skin in the game, since Americans by international standards already spend a lot out of pocket on health care. In many first world countries like the UK and New Zealand individuals pay very little health care cost out of pocket (i.e. skin in the game), yet their health care systems are radically cheaper than ours. A basic look at international health care costs and their relative public verse private spending shows there is little or no connection. In fact two of the most expansive health care systems, the United States and Switzerland, have the most private spending. If skin in the game was a real solution in keeping health care spending low, it should be the reverse. For decades rising co-pays and deductibles have increased Americans’ skin in the game, but our costs are still out of control and substantially higher than the costs in other first-world nations.
Keller goes on to offer his list of health care cost solutions that everyone should take seriously, even though they will do almost nothing to solve the problem.
b) Controlling our health care costs, which – as we are constantly reminded – are the highest on earth. This includes aggressive pilot programs that reward doctors who move away from fee-for-service into Accountable Care Organizations and bundled services; promoting living wills; reforming Medicare cost-sharing; and eliminating gimmicks states use to game the Medicaid program.
The menu includes some contentious moves that I think also deserve serious consideration. For example, raising the retirement age a bit, not for those who are on the verge of a long-planned retirement, but for those who are decades from retirement and have time to adjust. On the medical costs front, I think malpractice reform can reduce the proliferation of needless, defensive medical procedures, saving billions without putting patients at risk. There is no shortage of intelligent ideas for curbing entitlements without abandoning the vulnerable. But if politicians view this subject as too hot to touch, those ideas will go nowhere.
Where to even begin with this list of mostly useless or even counterproductive “solutions”?
- The CBO has concluded even extreme malpractice reform would barely save any money.
- Since Medicare is much more cost effective than private insurance, raising the retirement age for Medicare and forcing old people into private insurance would increase national spending on health care. Shrinking access to Medicare would also make the whole program less efficient per capita.
- Fixing “gimmicks” states use to get more federal money to spend of Medicaid would only increase state government spending or result in poor people being cut from the roles. It does nothing to control health care costs in general
- Fee for service is mostly a boogie man waved around to distract from the real problem. Many countries like Canada that use FFS still have much cheaper systems.
- Accountable Care Organizations are a new untested idea that has no track record to indicate it has value. It is even possible the concept will make the cost issue worse by encouraging provider consolidation and less competition. Given that every other country has radically cheaper care, we should adopt their long proven solutions, not put our hopes in new buzz phrase when even people in the industry can’t agree on what they actually mean.
The simple fact is that it won’t really matter what payment system we use as long as we are paying radically more for the exact same medicines or procedures as any other country. Until our government follows the example of all other first world countries by regulating the price providers and health care monopolies are allowed to charge, our system will remain insanely expansive.
If the best Keller can offer on the subject is regurgitating some of the most useless ideas and buzz-phrases he’s heard — but clearly never taken the time to understand — everyone would be better off if he stayed silent on the issue.
If Keller really wants to offer a proven solution to our health care spending problem and its effect on the federal budget, the answer is simple: adopt single payer or all-payer like the rest of the industrialized world. Adopting any other first world country’s single payer or all-payer system would effectively fix our long term deficit problem. That is the proven solution traditional liberals offer even if Keller uses the New York Times to falsely claim traditional liberals don’t offer a workable solution.