If the U.S. Supreme Court declares the essential “individual mandate” in the federal Affordable Care Act unconstitutional — or Republicans throw out the reforms — then it’s back to the past, back to the economy-dragging health care mess we’ve been calling a “system.”
Republicans say that Americans don’t want top-down government control of their health care. But what we have now is top-down corporate control of health care. Insurers, drugmakers, sellers of expensive equipment, hospital executives, labs, home-health-care services and others unnamed prosper by exploiting the chaos in our health care system.
They get other payers (be they private or government) to purchase $50 drugs when $10 drugs are just as effective. They make more money if patients have to be readmitted into the hospital. They profit from pushing surgery, when careful watching or less invasive therapy might do the trick at far lower cost and risk. They casually order CT scans without much thought to the expense or the patients’ exposure to radiation.
The motives are undoubtedly mixed. Some providers see opportunity in siphoning the poorly regulated Niagara of health care dollars into their pockets. Many doctors prescribe far more tests and surgery than do their colleagues, either out of habit or fear of being sued. (Republicans are right about the need for tort reform to curb litigation against responsible doctors.)
Here’s the point of an individual mandate requiring the uninsured to obtain coverage. The reforms call for state-run health-insurance exchanges, where the uncovered can find affordable health plans. The plans can’t remain solvent if young and healthy people can choose not to join them, leaving an insurance pool heavy with expensive sick people. Only a handful of states have moved forward on the exchanges, as others wait for the Supreme Court to rule on the individual mandate.
The 2006 Massachusetts health reforms, put into place by then-Gov. Mitt Romney, served as the model for the Affordable Care Act. Republican politics being what they are, Romney is now vowing to kill the national version of his reforms should he be elected president.
It happens that Romneycare was less conservative than Obamacare because it did little to confront rising health care costs. But a funny thing happened on the way to 2012. Polls show that folks in Massachusetts overwhelmingly support their universal coverage despite the expense. Instead of throwing it out, they’re seriously looking for ways to reduce the spending.
For example, providers may bill for every little test and treatment. Proposed legislation would encourage paying “flat fees” to doctors, hospitals and others to deal with the problem. That would remove the incentive to overprescribe care and reward those who do it right the first time.
Universal coverage, including an individual mandate, has evidently not hurt the Massachusetts economy. It may have even helped the state’s strong tech sector by providing health care security for entrepreneurs starting businesses. In any case, Massachusetts has the 14th-lowest unemployment rate in the country. And unemployment is even lower in high-wage Germany and Sweden, where the state guarantees far more generous health benefits.
Only government can force order into the jungle of profitable waste and crazy cross-subsidies — most of it piled on the backs of taxpayers and employers.
America can’t be modern without a system of universal coverage that promotes wise use of health care resources.
Let’s stop fooling around and get on with it.
Froma Harrop is a columnist for The Providence Journal.