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Amazed at His Moderation?


My father, the doctor who apparently went to history lectures instead of physiology lectures at Cambridge, used to love to quote the story of British colonial “hero” Clive of India. When Clive was investigated for excessive plunder, his defense to the British parliament was that he “stood amazed at my own moderation”. The Parliament of the time let him off, free to go plunder more. After a whole lot of fuss about what President George W. Bush was going to say in the State of the Union about health policy, we too can be amazed at his moderation. Given how keen this Congress and its leaders are on bribery, we can be sure that the result will be that the US health care system will enjoy much more plundering in the years to come. And largely the taxpayer is going to play the role of the plundered Mahahrajah.

Bush basically said nothing in Tuesday’s State of the Union speech. That’s partly because the main health care bill passed under his watch, the Medicare Modernization Act, was an act of plunder, that promised a prescription drug benefit program for seniors as its political cover. As has been reoeatedkt discussed – including in this special blog at TPMCafe – the implementation of the Medicare “Part D” drug benefit has been a total screw-up. The consensus is that Bush didn’t talk up any new health care reforms because he didn’t want to bring up Part D, or give the Democrats the chance to (justly) criticize the program in their response to his speech.

What might Bush push for now that the speech is over?

A little more malpractice reform? This might have a smidgen of a chance of getting by the Senate given the exit of Sen John (“Two Americas”) Edwards, and the Democrats’ minority status. Here in California we’ve already had the reforms the American Medical Association wants federally enacted here for decades, and you locals don’t exactly notice your premiums going down, do ya? Talk of malpractice reform did, however, provide one of the greatest Bushism’s of all time when he was upset that “OBGYNs weren’t able to practice their love with women all across the country.” (Yup, really — it’s on video here)

Association health plans? The idea here is that businesses could buy cut rate plans for their employee, which could allow them to duck state mandates. Forgetting the logic behind this proposal (and there ain’t much), this is an anathema to the currently dominant national plans (who are largely confederations of state-based plans), so it will never get out of Congress while AHIP (the big insurers’ trade association) is around.

How about greater tax relief for medical spending? Not only has The Economist pointed out that this is inflationary not deflationary, but the major part of this legislation, the Health Savings Account (HSA), has already been law since 2003. HSAs are growing not because they’re tax free — the second biggest health plan last week acknowledged that fully half of their HSAs do not have any contributions in them — but because the high-deductible health plans they are sold with are about all that those of us in the individual market can afford. HSAs are a public policy disaster — evident to anyone who can do basic math, but they’re not going to fundamentally change the system any time soon.

And what else did he say? Oh yeah. Better information and electronic medical records, and strengthening the doctor-patient relationship. Actually if we got the former it might harm rather than strengthen the latter, but don’t worry, unlike in the UK no government money will be spent on IT here any time soon.

Like the British Parliament with Clive, Congress let Bush wonder off without calling him on his abandonment of what even the U.S. public agrees is America’s major domestic problem. But whether or not Congress enacts any of this in the next session, it doesn’t really matter. We remain in a health care system that has no mandated universal access or insurance, virtually no restrictions on technology or services, and no-one responsible for its overall cost. Which leads to more and more health care cost increases for those who can pay, which leads to more and more un– and under-insured, with fewer able to pay the higher and higher costs. And so the cycle will continue, until it becomes bad enough for enough people that it becomes the dominant political issue.

That will take a little while longer and probably needs the next decent recession — possibly caused by the housing bubble bursting—to come about. Then we’ll have much more fun going back through the 1993–4 looking glass. So for now, the colonialists and plunderers have a while longer to move around the health care system making money off its innumerable and often inequitable illogicalities. Just don’t expect too much moderation from them.

Share  Posted by Matt Holt at 8:23 PM | Permalink

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