I just did something that I do occasionally when I want to be impressed with my own past insights: I dipped into my file of old columns and unearthed one from August 2009, about health care.
Remember? The Obamacare debate was in full flower, and the discussion was only slightly more contentious than it has been ever since — or is about to be again.
Here’s the problem, and it hasn’t changed: Everybody wants excellent, convenient, cheap health care. Good luck with that.
It’s pretty easy to plan for excellent, expensive health care or for cheap, mediocre health care, but changing those adjectives around is going to be next to impossible. The reasons are many and obvious.
Doctors are well-paid, and deservedly so. They spend literally half their working lives being educated, and suffer through some of the most stressful training imaginable. Hollywood plastic surgeons? Well …
Hospitals and medical offices are expensive. They are chock-full of fancy, expensive equipment that is always being improved or updated. Patients expect all this stuff. It cures what ails them.
Drugs are expensive. You can argue about comparisons with foreign countries and the cost of research and FDA delays, but the bottom line is that drugs will remain expensive because of costs, politics and demand.
Insurance is expensive because of all that other stuff.
The issues haven’t changed since that last column. Now the Republicans are going to make things all better; that is perhaps the most fundamental of their campaign promises.
Obamacare may be a terrible law; I haven’t tried to read or understand its 2,000-odd pages, but any plan hoping to provide consistent, quality, universal health care while reducing, or even stabilizing, costs, is a pipe dream.
Surely there are costs to be squeezed out at the margins. Paperwork is excessive and redundant. The long-promised electronic records database has not materialized.
Physician assistants can pick up some of the workload at a lower cost (just for other patients). Neighborhood clinics might help, but only if hospitals don’t compete like fast food restaurants. Then there is tort reform. We can dream.
But there are two incontrovertible facts overriding any of that: People now view health care as a right, and they are living longer — thanks to all that improved health care.
The right to health care in most wealthy countries is expressed in some form of universal government-run program. These programs appear to be free or cheap because they are paid for principally with taxes or yet more borrowed money. They tend to be bureaucratic and inefficient, because — well, most government programs are bureaucratic and inefficient. The cost is hidden, but the service can be very erratic.
In the United States, most of us still see the cost in the form of insurance premiums. There is no hiding it. The payment system is an incomprehensible hodgepodge of deductions and allowances and negotiated charges that I, for one, am happy to ignore. Thank you, Medicare and Blue Cross.
It doesn’t matter if health care is paid for by individuals, government, or money raining from the sky, it is going to be expensive. Lawmakers and insurance companies may fiddle with the allocation of costs to benefit the poor, but they won’t reduce them.
These facts are not going to change, and if whatever Republicans come up with — and I’m pulling for them — isn’t at least more straightforward and seen to bend the cost curve some, then the next election may well be the mirror image of the recent one.
Longtime columnist Fred Wolferman recently moved from Southern Pines back to his native Kansas City.