They're From the Government, and They're here to Help
What this level of (borrowed) spending tells me is that Congress is great at taking an arbitrary "stimulus" number in the multiple billions and divvying it up among the squeakiest wheels. But when it comes to true big-picture ideas on what needs to be fixed in healthcare—and a big part of what needs to be fixed is cost—I'm deeply skeptical that Congress has what it takes.
I know it's fashionable to think that the incoming administration will be able to fix healthcare, among many other problems it's inherited, but how much real influence can any executive branch, no matter how popular, have on such a systemic attempt at a fix? Meanwhile, expensive-to-administrate Band-Aids slapped on because they look "targeted"—like, for example, the COBRA coverage idea—isn't going to make any difference in the long run and I argue will provide little economic "stimulus" in the short run.
Instead, why not come with a big-picture idea, like a national version of Massachusetts' health insurance mandate that requires every person in the state to have insurance. It hasn't been perfect, but it has critics and advocates on both sides, which is a good first start. It's also dramatically cut down on the number of uninsured, and the cost per person has actually been less than expected.
The trouble with such a plan is that it wouldn't get rolling quickly enough to fit the bill of many in Congress who can't resist the urge to "do something now." Of course being seen as doing something, to many in Congress, is better than actually doing something substantive. The trouble with the kind of spending in the stimulus bill is that it seems to make so much sense that no one opposes it, yet when the details are ironed out, the spending only nibbles at the margins, making very little substantive difference.
But they're here to help.
Philip Betbeze is finance editor with HealthLeaders magazine. He can be reached at firstname.lastname@example.org.
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