The “Realistic” Way to Do Health Care Reform

There is a debate about whether we ought to do incremental health care reform as the political process allows us to do so, or whether that is a major waste of time unless we deal with all of the big problems--particularly soaring costs--in a comprehensive way.

This Massachusetts health care reform experience and all the problems it is having comes to mind as a case in point.

In March, the Senate Finance Committee held hearings on this topic of which--incremental or comprehensive--is the best way to proceed with national health care reform.

Witnesses generally agreed that it would cost $70 billion to $100 billion a year to enact universal coverage for the entire country.

The Massachusetts health reform challenge reminds us once again that you can’t fix the U.S. health care system if you can’t control its costs.

Longtime health policy expert, Stuart Altman of Brandeis University, someone I have come to respect over the years, made the point that trying to deal with both the uninsured and the cost of care at the same time would be politically impractical—dealing with the cost issues risks alienating a lot of key stakeholders. He suggested it would be best to cover the uninsured first and leave the cost to a second round of reform.

I guess what Stuart was really saying is that it’s best to get everyone into this leaky boat, and once that is done, and we have everyone really driving the costs even more out-of-control, we’ll have finally created the political imperative to finally fix the thing.

Looking at the pending experience in Massachusetts, one can see his logic.

Now, there’s a positive thought.