One Problem and Four Wrong Answers

Today's Los Angeles Times was a little weirder than usual. In the news section, I found a rather extraordinary article on one of the difficult problems in reining in health care costs. The biggest health care expenditures occur in the last two years of life (no surprise there), which means Medicare takes a big hit at that point because in most cases it is the insurer. What shocked me was that in the Los Angeles area, those costs are nearly double the national average. There is no single reason for that, but rather a complex set of factors, and the article takes a good look at some of those factors.

Some experts say high costs for patients at big-city hospitals such as White Memorial reflect a free-spending, out-of-control medical marketplace. Others say medical costs are higher in urban areas because the poor need more care and the rich demand it. Others say the profit motive is at play.

Still others say that when lives are at stake, cost should not be an issue.

Whatever the reason, the question itself has taken on added importance as the Obama administration pushes a massive expansion of medical care to the uninsured. In campaigning for a healthcare overhaul, President Obama has made repeated calls for changes that will help "Americans avoid the unnecessary hospital stays, treatments and tests that drive up costs."

OK, so the style sucks ("some say" should be banned from any news report), but the article does raise the right issues and surveys some of the answers. All in all, the article is well worth the read.

The article is not the weird part, however. That comes in the editorial section where four conservatives (none serving in Congress at the present time) step forward with their views on what would fix the whole health care problem. The names are very familiar, as are the views.

First up (and go hide your cat) is former Sen. Bill Frist, whose suggestion is that we "Focus on Wellness:"

The key word is "interventions." Think about it: Having more people getting more health screenings, mammograms, pap smears and colonoscopies has to cost more money.

While we want such services to be widely available, reform that concentrates merely on offering more of those things isn't the way to fix what ails the nation. Instead, we need a system that concentrates on keeping us well, so we need less "healthcare" and fewer "preventive interventions" in the first place.

The major determinants of health are not doctors, hospitals, universal insurance, public plans and expanded health services. Much more significant is behavior -- things such as diet, exercise, smoking and drinking -- basic education and socioeconomic status. So if the goal is to make us healthier, to lower the burden and thus the societal costs of disease, policymakers in Washington must actively promote health and wellness. And the way to do that is by providing incentives for the implementation and sustained use of employer-backed wellness programs.

So, quit smoking, drinking, eating fried foods, and start exercising and stay in school and all will be well in the land, at least eventually. For those too far along for such a program, or who don't have an employer willing to fund a wellness program, well, too bad for them. They'll have to live/die with their own choices.

Next up is Mickey Edwards, whose idea is "Solve the urgent healthcare problems, and leave the rest." His idea on what the "urgent problems" is also unsurprising:

Step one: Authorize creation of an alternative, non-government source of insurance -- a "pool" that would allow the uninsured, self-insured, etc., to join in a private plan that would not be tied to any particular employer or association. This plan already has a great deal of bipartisan support and could easily be brought to life.

Step two: Corporations are creatures of government, provided with special government protections against the kinds of liability that plain citizens might face in providing goods or services. All "government creations" (radio and television stations using the public airwaves, for example) face certain restrictions as a price for the government benefit they receive. While insurance companies might have to charge more for covering an event that is very likely to occur (increasing the insurer's risk), they could, as government-empowered entities, be required to insure those with preexisting conditions and cover any recurrences or ongoing problems linked to those conditions.

Sound familiar? It should: that's what Max Baucus is touting. Funny how some things don't make any sense no matter which side of the aisle utters it.

Third on the list comes from David Frum whose mantra is "Give insurers more power."

The big problem with America's private-sector health insurance companies is that they are not nearly powerful enough. ...

What we need instead is to assert federal regulatory authority over the whole marketplace and get the states out of healthcare altogether. Let the insurers do business as national entities; let the market contract to four or eight major insurers; and then let them do unto their suppliers as Wal-Mart does unto its suppliers: squeeze them.

Suppliers will respond by searching fiercely for efficiencies and economies.

Most things cost less in the United States because America's huge internal market allows for mighty economies of scale. In health insurance, Americans have forgone those advantages too long. Liberals want the federal government to displace the private insurers because (they claim) capitalism fails in healthcare. Before succumbing to state control, though, wouldn't it be wiser to allow capitalism a fair and national try?

Been there, done that, which is why we are where we are. You want economies of scale, turn it over to the government and let the new version of Medicare beat on the cheaters. Sheesh, what a moron!

Finally, there's Richard Viguerie, who picks up where David Frum left off. His insight is "Conservatives encourage competition in healthcare:"

First, it's time for honesty from Democrats, Republicans and the health profession. People don't know their own healthcare costs when they're covered, therefore they don't shop around for better prices and there's less incentive to keep costs low. Health savings accounts would put sanity back into the system because people would have "skin in the game." When people spend their own money, they spend it more wisely.

Second, government must not directly or indirectly control healthcare. Democrats and Republicans have demonstrated time and again that they succumb to special interests. Keep the government's nose out of patient-doctor relationships and do not create a government database of medical records.

Third, respect constitutional constraints, which means most federal involvement is barred or limited. Use the commerce clause of the Constitution productively, as it was intended, to break down inefficient barriers to interstate commerce. Allow citizens of any state to choose from what's available in all 50 states. Let consumers carry their coverage from job to job and from state to state. Include reasonable tort reform, but only consistent with the Constitution.

Fourth, don't discourage profit. The desire for profit drives better prices, service and products.

Oh, the apotheosis of conservative brilliance! It burns! And it stinks. Apparently Mr. Viguerie still has faith in the executives of AIG, Country Wide Finance, and the Chrysler Corporation. Look, Richard, nowhere in the US Constitution is it mandated that the desire for profit shall be sated at the cost of healthcare. Get over it.

So, that's the thinking and the proposals from the conservative luminaries offered by the Los Angeles Times. This certainly explains why people like Rep. Boehner and Sen. McConnell haven't offered a competing plan.

They. Got. Nothing.