A 2009 Prologue to Health Reform

What’s past is prologue.

Shakespeare(1564-1616), The Tempest


January 15, 2012 - Back in 2009, a year before the Accountable Act passed, I wrote the following in Obama, Doctors, and Health Reform: A Doctor Assesses the Odds for Success (IUniverse).

Buyers managed to stay away from the book in droves, so I will not hurt if I repeat now what I said then about my book
“It’s a history lesson. There’s no mystery to history. It’s the present and future that’s obscure.

When Medicare and Medicaid passed in 1965-1966, the Johnson Administration assured us the combined programs’ cost wouldn’t exceed $9 billion. Now, 43-to 44 years later, the cost approaches $1 trillion, may double in five more years, and threatens to bankrupt government.

What’s the lesson?

There are four lessons.

One, if you think health care is expensive now, just wait until we have “free” government care. Anytime you have a government program, people will fine ways to “game” the system, driving up costs. The government will have to decide selectively what it can pay for, not how it can pay for everything. Rationing is inevitable, but it will be called paying for “priorities’ or “evidence-based” medicine.

Two, when you expand coverage, you invariably spend more money. As sure as dawn follows darkness, expanded government coverage will drain the federal treasury.

Three, money, even federal money, isn’t unlimited. No tree, no fee, grows to the sky. There’s no free lunch and no free-for-service. If you’ll pardon a couplet of clichés.

Four, complexity science and chaos theory is at work. A butterfly flapping its wings in Brazil can cause a tornado in Texas, and 5% of foreclosed mortgages in California can Bring down Wall Street, even the world economy,. The same forces are work in health care.

Do you detect a note of cynicism?

No, what you detect is realism based on experience. The only long term solution is to make people pay something out-of-pocket for health care, with a cap on unaffordable catastrophic and with unspent tax-free money set aside for retirement.

But that will not happen in a society like ours accustomed to entitlement, and a mindset among politicians that health consumers can’t be trusted to fend for themselves, to interact with their doctors, and to take personal responsibility. It goes without saying that politicians don’t think doctors can be trusted to do the right thing either- if money is involved.

Tweet: If the history of Medicare and Medicaid is prologue, the future affordability of these programs is in doubt.