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Monday, February 22nd 2010

White House Goes In

So Obama, after letting the Democratic caucuses flounder around for a year, has put his own proposal on his table. Nothing much new here. It tinkers with the Senate’s passed bill but in modest ways. The Wonk Room has a chart comparing the options.

It lacks any sort of public option in the form of new offerings or expansion of current government-as-payee offerings. It lacks even the national exchange. And of course it misses tort reform.

I know how the CBO scored the Senate bill, and Obama’s plan will get something similar and maybe something a little more impressive if the government actually gets to comment on each health insurance premium increase and such is passed on to providers. But real cost control and thus long term and permanent expansion of access to care is beyond the scope of Obama’s proposal.

Kent Bottles has a good summary of media coverage of why cost control is so difficult. I know plenty of pundits find him easy to disparage but I’m with Dr. Uwe Reinhardt on this. As Bottles’ quotes from a linked NY Times piece,

[R]eaders should replace the term ‘cost control’ in their minds with ‘constraining and possibly reducing the future incomes of doctors, hospitals, pharmaceutical companies, medical device companies and so on.’” He goes on to say that given our system of governance where political contributions mean so much, “the task of constraining or reducing the incomes of American health care providers will be a long and arduous battle with powerful, moneyed interest groups.

Only a global budget eases the political situation enough to allow for lower reimbursements and in turn reduced costs. Only a global budget can affect rationing in a sustainable way. Only a global budget can contain costs long term. Only cost containment on the order offered by a single payer or socialized system will allow the expansion of access to care enough to term it universal. Otherwise, forget that goal…at least not long term.

Not to sound like a progressive, I’m not as I cheered a Paul victory on at CPAC, but if Obama is really looking for reform he’s missed.