Robert J. Samuelson has a good article at the Washington Post on some of the Illusions of Cost Control. He makes a pretty good point about politics in this country: We ALWAYS take the easy/obvious way out:

There’s a parallel here: housing. Most Americans favor home ownership, but uncritical pro-homeownership policies (lax lending standards, puny down payments, hefty housing subsidies) helped cause the financial crisis. The same thing is happening with health care. The appeal of universal insurance — who, by the way, wants to be uninsured? — justifies half-truths and dubious policies. That the process is repeating itself suggests that our political leaders don’t learn even from proximate calamities.

Argument 1: The uninsured use expensive and ineffective emergency rooms for primary care. Once they’re insured, they’ll have regular doctors. Care will improve; costs will decline.

UNTRUE

A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was “more convenient” to go to the emergency room or they couldn’t “get [a doctor's] appointment as soon as needed.” If universal coverage makes appointments harder to get, emergency-room use may increase.

Argument 2: Insuring the uninsured will dramatically improve the nation’s health and thus decrease healthcare costs.

UNTRUE

Medicare’s introduction in 1966 produced no reduction in mortality; some studies of extensions of Medicaid for children didn’t find gains. In the Atlantic recently, economics writer Megan McArdle examined the literature and emerged skeptical. Claims that the uninsured suffer tens of thousands of premature deaths are “open to question.” Conceivably, the “lack of health insurance has no more impact on your health than lack of flood insurance,” she writes.

How could this be? Possible explanations include: (a) many uninsured are fairly healthy — about two-fifths are age 18 to 34; (b) some are too sick to be helped or have problems rooted in personal behaviors — smoking, diet, drinking or drug abuse; and (c) the uninsured already receive 50 to 70 percent of the care of the insured from hospitals, clinics and doctors, estimates the Congressional Budget Office.

Here’s the bottom line on healthcare cost control:

Unless we change the fee-for-service system, costs will remain hard to control because providers are paid more for doing more. We have to change the provider INCENTIVE! Just giving people free health insurance makes the problem worse. Healthcare providers will be able to continue doing more and getting paid more because there will be NO INCENTIVE for consumers to shop for the best prices OR control their own costs!

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