Megan McArdle writes that the claim “We will control health care costs, because we have to”
is a disturbingly common argument heard when one points out that the costs of the domestic programs we have are so far impervious to cost control. Apparently, it is safe to enact a program that is going to blow a 10-gauge hole in the Federal budget, because the mere fact that we can’t currently afford to pay for it will force us to, um, do something.
Both the House and the Senate health care reform bills pay for themselves, according to the CBO. So it’s not clear what program Megan thinks will “blow a 10-gauge hole in the Federal budget.” But here’s the broader point: the US is going to have to shrink the amount the government pays for health care. This is true whether or not we create universal health insurance, because growth in Medicare and Medicaid costs will bankrupt the government otherwise over the next 2 decades. The question is who will pay for this shrinking of the amount we pay for health care. Under the current system, the following groups are paying for it: the working poor, who are gradually being priced out of the private health insurance market but don’t qualify for Medicaid. And the sick, who are slowly being kicked out of private health insurance at any point where insurers can find a legal loophole that enable them to kick them out. To be more precise, then, it’s the unlucky sick who are paying, those who get fired while sick, whose business go bankrupt while they’re sick, who filled out something wrong on a form that gets their coverage rescinded, etc.
This is an unacceptable way to pay for the rising cost of health care — by denying coverage to the working poor and the unlucky sick. Before we decide how we’re going to cut government spending on health care, we have to ensure that everyone in the country has health insurance. And the method of saving money should not be, by and large, to cut services to the poor. We in the US believe that no one should go without health insurance or basic, decent health care because they are too poor to afford it. That’s why we have Medicaid and Medicare. It is utterly irrational to continue to guarantee large overpayments to seniors on Medicare Advantage while the working poor are gradually forced to go without health insurance entirely. We need to set up a system that guarantees that everyone gets health insurance. Then we can start making cuts, once there’s a way for such cuts to be shared by everyone, on the basis of solidarity, rather than just cutting the throats of the working class.
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