They're From the Government, and They're here to Help

That's the punchline from that old joke attributed to Ronald Reagan about the nine most terrifying words in the English language. I thought of that phrase after seeing details on how the $825 billion Obama stimulus bill would be divvied up, should it pass. To be sure, there's a lot of healthcare in the bill, but there's precious little healthcare reform.

With appreciation to CIT Healthcare's John Cousins, who monitors government healthcare spending better than anyone I know, here's how the bill breaks down (Stay with me after the following list, because it's long and cumbersome):

Major healthcare spending included in the bill are:

• Medicaid aid to states: $87 billion, increasing through the end of FY 2010 the share of Medicaid costs the federal government reimburses states.
• COBRA healthcare for the unemployed: $30.3 billion to extend health insurance coverage to the unemployed, extending the period of COBRA coverage for older and tenured workers beyond the 18 months provided under current law. The subsidy will be at a rate of 65% of the premium for the first 12 months of COBRA coverage for eligible persons who have lost their jobs on or after Sept. 1, 2008.
• Medicaid coverage for the unemployed: $8.6 billion to provide 100% federal funding through 2010 for optional state Medicaid coverage of individuals (and their dependents) who are involuntarily unemployed and whose family income does not exceed a state-determined level, but is no higher than 200% of poverty, or who are receiving food stamps
• Health information technology: $20 billion to jumpstart efforts to computerize health records to cut costs and reduce medical errors
• Prevention and wellness fund: $3 billion to fight preventable chronic diseases.
• Healthcare effectiveness research: $1.1 billion for Healthcare Research and Quality programs to compare the effectiveness of different medical treatments
• Community health centers: $1.5 billion, including $500 million to increase the number of uninsured Americans who receive quality healthcare and $1 billion to renovate clinics and make health information technology improvements
• Training primary care providers: $600 million to address shortages by training primary healthcare providers, including doctors, dentists, and nurses.
• Indian Health Service facilities: $550 million to modernize hospitals and health clinics and make healthcare technology upgrades.
• National Institutes of Health biomedical research: $2 billion, including $1.5 billion for expanding good jobs in biomedical research to study diseases such as Alzheimer's, Parkinson's, cancer, and heart disease and $500 million to implement the repair and improvement strategic plan developed by the NIH for its campuses

I'm not arguing about whether certain sectors in this bill deserve funding. Some do. I might feel like I deserve a raise, too, but it sure isn't coming if my company can't balance its books. And the federal government, as we've seen, can't even come close to balancing its books.

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.

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