"One Cannot Measure What One Does Not Manage": Healthcare for All-What's it Gonna Cost? (Part XIII-q)

July 16, 2009
Jeff Kaplan

How much will it cost to develop and maintain a durable, access facilitated, variation reduced, efficient and cost-effective healthcare system that also includes a doc-payment fix?

How much will it cost to develop and maintain a durable, access facilitated, variation reduced, efficient and cost-effective healthcare system that also includes a doc-payment fix?

Gilbert R. (Academic group's CEO), the realist said on May 1, 2009 5:06:49 PM EDT

"John Sheils, a senior vice president of the Lewin Group, said about $1.5 trillion to $1.7 trillion would be a credible estimate for a plan that commits the nation to covering all its citizens. That would amount to around 4% of projected health care costs over the next 10 years."

But wait, the Congressional budget blueprints that just passed both houses have no money in them to fix even the Medicare physician fee problem-starting with the 21% cut the docs are facing on January 1st.

In the CBO's December report on healthcare options, they said fixing the cuts by freezing physician payments where they are and then increasing them by inflation each subsequent year would cost $556 billion over ten years. It would likely cost about $250 billion to just freeze the Medicare doc fee schedule at current levels for ten years.

So, a universal access health bill would cost at least $1.2 trillion and unless the Medicare docs are going to get a series of fee cuts-starting with a 21% cut soon-we need to add the cost of a doc fix. That's another $556 billion to keep them even with inflation-for a total of at least $1.75 trillion.

I'd pose fewer questions to Arlen Specter and the now filibuster-proof majority; instead I'd ask the optimistic healthcare reform committee chairmen the following:

  1. How much will it cost to develop and maintain a durable, access facilitated, variation reduced, efficient and cost-effective healthcare system that also includes a doc fix?
  2. Whose hide are you going to take the money out of to pay for it?

Then I'd ask Arlen Specter-and everyone else-if they'll vote for it.

Fredrick H. (MD, PhD, JD), the curmudgeon said on May 1, 2009 5:44 PM

The alleged "cost" of a government health plan means nothing unless compared to the savings to individuals and corporations from no longer having to buy private insurance and its annoying bureaucratic layer, and to counties and providers from no longer having to bear the expenses of the uninsured. So, if you can't estimate that current cost, don't bother to quote the cost of the new plan.

As for Arlen Specter, he's quite progressive on health care. For instance, he's interested in a bill that would wipe out employer-based health insurance, altogether. Great! That's better than fixing ERISA, if you can do it. Now with Bush and the Republican troglodytes out of the way, I suspect that that's what he'll push for. And, on this issue, I think he's more progressive than the Democratic Congressional leadership. I wouldn't call this "Democrats ramming through legislation", but rather "Democrats finally overcoming the Republican logjams of the last 30 years to achieve the system that the great majority of Americans already support."

But, Gil, isn't that impossible scenario you suggested just what politics is made for? "I'm here to help ya!