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Sunday, March 3, 2013

Steven Brill On ObamaCare

I haven't read it, but eventually I will; most of what I write below is what I remember from hearing him on the Diane Rehm show on Wednesday Feb. 27.  Steven Brill has done the research and has arrived at the obvious conclusion -- the problem with ObamaCare is that it does almost nothing to control costs.  He makes the point that the the Health Care lobby -- insurance companies, hospitals, and the pharmaceutical industry -- is by far -- very far -- the biggest lobby in Congress.  Apparently it simply dwarfs all competitors, including both the military industrial complex and the oil and gas industry.

In fact, by sending people to private insurers, ObamaCare goes in exactly the wrong direction.  Right now, Medicare is able to negotiate much better rates than private insurers.  The obvious question for the health care reformers was why not build on that and give everyone Medicare or something like it?  That might have been Obama's original "single payor" vision, but he abandoned it for the sake of compromise, and now we've got what we've got.  And it's going to be all the harder to pass real reform  after all the political capital spent passing ObamaCare.

The point came up when a caller asked why Congress is currently considering the idea of raising the age of Medicare eligibility as a way to "save" money.  The caller pointed out, and Brill agreed, that that's exactly backward -- if the goal is to "save" money -- i.e. reduce the nation's health care costs -- we should be lowering the age for Medicare eligibility, not raising it.  Those "older" people still need healthcare -- in fact, ObamaCare mandates that they get it -- and we are now just forcing them to get it at a higher rate.

The Supreme Court has now told us that ObamaCare's mandatory insurance is a "tax" -- we need to be thinking of it as a tax, especially when we are trying to balance the budget.  Raising the Medicare eligibility age thus imposes this "tax" on consumers who are forced to buy insurance, and that tax money just ends up going to the insurance companies.  So really, the idea of raising the Medicare eligibility age is just one more form of corporate welfare -- yet another transfer of our tax dollars to corporate America.

There has been a good deal of criticism of an reaction to Brill's article, and I haven't read much of that either.  Here's something from the Washington Post.  The real question though is why these debates didn't occur in Congress and the White House when ObamaCare was being pushed through.

The basic problem is that unlike in any other area, consumers have very little choice at all in health care, and thus very little bargaining power.  The result is that they can be charged seventy-odd dollars for four boxes of gauze pads, or $1.50 to a tylenol tablet.  In every other industry, there is competition and choice -- if a consumer doesn't want to pay $50 for a bandaid, he could just go to the next vendor.  But that's not the way healthcare in America works.  And the one thing that consumers might conceivably have had -- the ability to collectively say "enough is enough, we won't pay more than x, y, and z for this that and the other -- has basically been taken from us by ObamaCare, which simply mandates that we buy insurance, and let the insurance companies and health care providers work out the cost of health care.  Note that what I am advocating is what Brill is advocating as well -- government price controls on health care.  It's easy for capitalists to argue that price controls are a form of socialism.  But in this case, that's not really what it is -- it is (or should be) simply the PEOPLE'S way of bargaining for a product that they pay for.  Government FOR THE PEOPLE should be effectuating that -- instead, it is taking away people's ability to do that.

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