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Jewish World Review March 15, 2010 / 29 Adar 5770 Obama's illusions of cost-control By Robert J. Samuelson http://www.JewishWorldReview.com | "What we need from the next president is somebody who will not just tell you what they think you want to hear but will tell you what you need to hear." -- Barack Obama, Feb. 27, 2008 One job of presidents is to educate Americans about crucial national problems. On health care, Barack Obama has failed. Almost everything you think you know about health care is probably wrong or, at least, half wrong. Great simplicities and distortions have been peddled in the name of achieving "universal health coverage." The miseducation has worsened as the debate approaches its climax. There's a parallel here: housing. Most Americans favor homeownership, but uncritical pro-homeownership policies (lax lending standards, puny down payments, hefty housing subsidies) helped cause the financial crisis. The same thing is happening with health care. The appeal of universal insurance -- who, by the way, wants to be uninsured? -- justifies half-truths and dubious policies. That the process is repeating itself suggests that our political leaders don't learn even from proximate calamities. How often, for example, have you heard the emergency-room argument? The uninsured, it's said, use emergency rooms for primary care. That's expensive and ineffective. Once they're insured, they'll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it's untrue. A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was "more convenient" to go to the emergency room or they couldn't "get [a doctor's] appointment as soon as needed." If universal coverage makes appointments harder to get, emergency-room use may increase. You probably think that insuring the uninsured will dramatically improve the nation's health. The uninsured don't get care or don't get it soon enough. With insurance, they won't be shortchanged; they'll be healthier. Simple. Think again. I've written before that expanding health insurance would result, at best, in modest health gains. Studies of insurance's effects on health are hard to perform. Some find benefits; others don't. Medicare's introduction in 1966 produced no reduction in mortality; some studies of extensions of Medicaid for children didn't find gains. In the Atlantic recently, economics writer Megan McArdle examined the literature and emerged skeptical. Claims that the uninsured suffer tens of thousands of premature deaths are "open to question." Conceivably, the "lack of health insurance has no more impact on your health than lack of flood insurance," she writes. How could this be? No one knows, but possible explanations include: (a) many uninsured are fairly healthy -- about two-fifths are age 18 to 34; (b) some are too sick to be helped or have problems rooted in personal behaviors -- smoking, diet, drinking or drug abuse; and (c) the uninsured already receive 50 to 70 percent of the care of the insured from hospitals, clinics and doctors, estimates the Congressional Budget Office. Though it seems compelling, covering the uninsured is not the health-care system's major problem. The big problem is uncontrolled spending, which prices people out of the market and burdens government budgets. Obama claims his proposal checks spending. Just the opposite. When people get insurance, they use more health services. Spending rises. By the government's latest forecast, health spending goes from 17 percent of the economy in 2009 to 19 percent in 2019. Health "reform" would probably increase that. Unless we change the fee-for-service system, costs will remain hard to control because providers are paid more for doing more. Obama might have attempted that by proposing health-care vouchers (limited amounts to be spent on insurance), which would force a restructuring of delivery systems to compete on quality and cost. Doctors, hospitals and drug companies would have to reorganize care. Obama refrained from that fight and instead cast insurance companies as the villains. He's telling people what they want to hear, not what they need to know. Whatever their sins, insurers are mainly intermediaries; they pass along the costs of the delivery system. In 2009, the largest 14 insurers had profits of roughly $9 billion; that approached 0.4 percent of total health spending of $2.472 trillion. This hardly explains high health costs. What people need to know is that Obama's plan evades health care's major problems and would worsen the budget outlook. It's a big new spending program when government hasn't paid for the spending programs it already has. "If not now, when? If not us, who?" Obama asks. The answer is: It's not now, and it's not "us." Pass or not, Obama's proposal is the illusion of "reform," not the real thing. Every weekday JewishWorldReview.com publishes what many in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here. Comment on Robert J. Samuelson's column by clicking here. 01/14/10: In the aftermath of the Great Recession 12/29/09: Democracy's demolition derby 11/30/09: Bipartisan threats against the institution that saved America from depression 09/14/09: Give It to Us Straight 09/07/09: Bad Future for Jobs? 08/24/09: A Rail Boondoggle, Moving at High 08/10/09: Championing the Status Quo 08/03/09: We'll remain in denial, prisoners of wishful thinking, until the fateful reckoning arrives in the unimagined future 07/27/09: Obama's misleading medicine 07/13/09: Americans' self-indulgence hurts us 07/06/09: Economists out to lunch 06/29/09: Panics ‘R’ Us! 06/08/09: Flirting with deflation or inflation? Now the economy might be at risk of both 05/25/09: A ‘crisis’ America needs 05/18/09: Will somebody finally say that Obama is irresponsibly mortgaging our future? 05/04/09: The Bias Against Oil And Gas 04/27/09: Environmentalists maximize the dangers of global warming while pretending we can conquer it at virtually no cost 04/20/09: Our Depression Obsession 03/23/09: Geithner treads a line between financial paralysis and populist resentment 03/23/09: American Capitalism Besieged 01/06/09: The limits of pump priming 12/29/08: Humbled By Our Ignorance 07/31/08: The homeownership obsession 07/24/08: A Depression? Hardly 07/17/08: Why isn't globalization making the interconnected world more stable? © 2009, WPWG

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