It is indeed complex as this flow chart depicts. (Click to enlarge) It reveals all the interconnections necessary to support the provisions of the current bill that were debated in the House recently.
This is not to say that the current, private system of coverage is simple!!
President Obama offered the following remarks about the importance of health care reform and the challenges it presents (February 24, 2009): I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must not wait, and it will not wait another year.
We recently found that the House bill would fail to contain costs--one of the primary goals--and could actually worsen the problem of rapidly escalating medical spending.
We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount, says Douglas Elmendorf, director of the Congressional Budget Office. On the contrary, the legislation significantly expands the federal responsibility for health-care costs.
Upon hearing these remarks, leading lawmakers are expressing concern. Representative Mike Ross (Arkansas-D) said, We have to take steps to hold health-care costs to the rate of inflation, or we will never balance our federal budget again and health-insurance costs will continue to become less and less affordable for the American people.
From Utah we heard Representative Jim Matheson (D) opine, If we don't reform the system to get costs under control, then nothing else matters. We're just putting more people into a broken system.
When asked whether the bill moving through Congress would bring the health-care cost curve under control, the CBO director replied, The cost curve is being raised.
The House bill is estimated to cost $1 trillion to $1.5 trillion over 10 years. To pay for it, the White House has proposed raising taxes by $544 billion, almost all on the rich. That still leaves a massive shortfall. Where will it come from??
Our government proposes that it will be able to save that amount. But how will that happen? Most likely it would be through rationing of health care, ie, less medical care and perhaps lower quality. CBO director Elmendorf sees no savings from the health reform plans offered. He figures that current legislation would raise costs.
If savings doesn't work, then we either need to tax the middle class, or hope to borrow massive additional amounts--further bloating the US debt.
So what can we learn from Massachusetts? Three years ago they enacted a law that required every resident to have medical insurance. Commonwealth Care was created to subsidize those who couldn't afford to buy their own. This received bi-partisan support.
It didn't take long for the program to run into trouble. Costs soared from $158 million in the first year to $630 million in 2007, then doubled in 2009 to $1.3 billion.
Demand overwhelmed the system, just as demand has led to medical care rationing in Great Britain and Canada.
Now the state is dropping coverage for 30,000 people because not enough money is around to pay for everyone.
Recently a Massachusetts panel proposed that the state scrap traditional payments to doctors and hospitals for each office visit or procedure, and instead adopt a system where they receive a monthly or annual fee per patient. The proposal is an effort to control the state's health-care costs, which are among the highest in the nation.
The Massachusetts health care law has attained near-universal health insurance coverage. It has served as a model for national plans now being debated in Congress. But the Massachusetts plan has done little to control costs, which now are 33% higher than the U.S average and projected to grow faster than the rest of the country.
You now see some of the enormous complexity surrounding this issue; and the danger of getting this federal program wrong. It is indeed a monumental challenge.
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