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Universal coverage. You can keep what you have. You’ll save money on your health insurance. A public plan will promote competition and keep costs down.
Does health care reform add up? Let’s look at the numbers.
According to the Census Bureau, almost 46 million people were uninsured for the entire year in 2007. This estimate tells us nothing about the number of people who really need help from taxpayers to buy insurance. The Census Bureau figure includes some people who were uninsured all year and others who were uninsured for a few weeks or months–often because they changed jobs and could not keep their coverage. Twenty percent of the uninsured lived in high-income households. A Baruch College study finds that 17 million uninsured Americans between 18 and 65 years old had enough income to buy health care coverage.
Being uninsured does not mean you cannot get health care. By law, hospitals are required to treat patients who need the care, whether they have insurance or not. If you had to prove that you have insurance before any care was rendered, many victims of crime and accidents would bleed to death while the financial details were being verified. The uninsured used health services costing $83 billion in 2008, according to an Urban Institute study. About $54 billion of that was free care, paid by public subsidies and higher charges on patients who have insurance.
During the 2008 presidential campaign, then-Sen. Barack Obama said his plan would save the average family $2,500. Costs could be rolled back by reducing overhead in the insurance industry, computerizing patient records and improving treatment decisions.
The Congressional Budget Office has repeatedly shown that such ideas might improve health care quality, but they are unlikely to produce significant savings over the next decade. Even if the cost savings materialize by the end of the next decade, the average family will still pay more for health insurance than they do today. A $2,500 savings would be swamped by the continued rapid rise in health care costs.
Senate Democrats have decided that health reform should cost no more than $1 trillion over the next decade. A trillion dollars doesn’t buy that much any more, according to the CBO, which found that Sen. Ted Kennedy’s reform proposal would cover only an additional 16 million people. That works out to $62,500 for each newly insured person. Most of the money would be spent to subsidize people who already have insurance.
One of the thorniest political issues is whether to create a public plan as an alternative to private insurance. Proponents argue that a health plan run by the government is needed to force private insurers to compete. They claim that a public plan would have low administrative costs and the ability to drive down prices paid to health care providers. What they don’t often admit is that we already have a “public plan.” It’s Medicare, which is underfunded and poorly managed. Over the next 75 years, Medicare will be short $37.8 trillion even though the government pays about 20 percent less for the same services as private health plans.
There is no question that the U.S. health system has long needed reform. Whatever the true number is, too many people do not have health insurance. Although they have access to health care, that care is often neither timely nor appropriate.
But having insurance is no guarantee that you will receive the services you need when you need them. The solution to these problems is not a top-down reform that further centralizes power and decision making in Washington, following in the footsteps of the auto industry takeover. Regrettably, that is what many in Congress seem to be pushing.
There is one more number that matters in this debate: your bank account number. Regardless of the political promises, you will be paying for whatever passes for health care reform this year.
Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI.
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