May Congress follow the lead of Blizzard Entertainment, and vote on the health care bill “when it’s ready.” Ezra Klein, who’s essential reading on health care reform, points out some of the cost control measures being considered.
The first comes from the excise tax on high-cost health insurance plans. The idea here is simple enough: you’re taxing any growth in health-care premiums that’s faster than the rate of growth in GDP plus one percentage point, which is going to make people a lot less accepting of premium increases and unchecked growth. This is, in the simplest sense of the term, a cost control. In theory, it controls costs by taxing one of the drivers of cost growth into submission. It is, by far, the policy economists are most united on, and the one that works in the most straightforward and blunt way.
The second comes from the newly formed Medicare Commission, which is a lot stronger than people realize. The idea isn’t simply that a panel of experts gets to dream up interesting reforms to try out in Medicare. It’s that they are charged with making sure that Medicare hits certain growth targets, and their package of reforms has to achieve that goal. Those reforms are then sent to Congress, where Senate debate is limited to 30 hours, and amendments must be both budget neutral and “germane.” This report, in other words, is exempt from the filibuster. So far as anything is ever easy to pass, this is easy to pass. If Congress cannot manage action even within this streamlined process, then it simply cannot cut health-care costs at all, and our federal government will go bankrupt.
The third is the delivery-system reforms. The House bill has these too, though they’re a bit weaker. They key alchemy, however, is the interplay of the delivery-system reforms and the MedPAC commission. The Senate builds in a lot of pathways by which an idea that starts in Medicare through the commission and proves successful can be brought to pilot and then brought to scale across the health-care system. Medicare serves as the laboratory, but other institutions created in the bill serve as the factory.
All three of those stories make sense, and any of them, on their own, would represent the most significant effort at cost control in a generation, if not ever.
We really have no choice but to take our time to truly address cost control as part of health care reform. The long term costs of health care demand it. Our current system is fundamentally broken.
Within the next fifty years, medical technology is going to advance to levels that we simply cannot properly gauge in 2009. Life expectancy will, barring interference from energy and climate issues, increase, perhaps significantly. By the time I am eighty years old, it is entirely conceivable that I may have access to technology that will allow me to live to 150, or 200 years. To live indefinitely is not out of the question. What we have come to understand in the last ten years will pale next to what we will have mastered by then.
Very likely then that the same kinds of research will yield benefits on how to keep us healthier longer. At eighty, I may have strengthened bones and more muscle mass than I possess now. Nano-tech may be cleansing my blood. Yet, despite all these measures, an extended life creates a bigger window for costly life-threatening issues, and simply persisting may be a hugely expensive undertaking itself.
In such a world, notions of when we should retire will face upheaval. Working 47 years and living another 150 simply won’t be feasible. More than ever, sustainability will be a part of our vocabulary. If you’re 100 with the body of a 50 year old, you will be expected to work. The very concept of retirement may become drastically altered or largely obsolete, reserved for the wealthy.
Addressing long-term costs isn’t merely a panacea for teabagging fools who suddenly woke up to the deficit the day George W. Bush left office. Sustainability must remain a constant concern, whether the subject is health, energy, or preserving our Constitutional rights.
Let Congress work on it, and make real cost control part of the final bill. The cries of the foolish will diminish, and we will see who is dedicated to solving difficult problems responsibly.