Cutting to the chase on health care

Josh Marshall:

Here is the simple secret of health insurance and health care provision policy: You can create efficiencies and savings by constructing functioning markets. But at the end of the day, more money equals more care. Or in the proxy we judge these things by, more money means more people are insured. If you see a plan that costs a lot less money than Obamacare, it means many fewer people will be covered. It’s as simple as that. You may have to look closely at the details to see just where the care reductions are made. But it’s there, just as certain as night follows day.

Yep.  We spend way too much for all sorts of complicated reasons and we sure as hell need to work on that.  But, for now, barring the dramatic changes needed to change that “spend way too much” dynamic, more spending equals more care and access.  Thus:

The problem is that over the course of seven years Republicans have essentially accepted the premise of the ACA: which is to say, the people who got coverage under the ACA should have coverage. That’s what’s made ‘replace’ all but impossible. That’s why we’ve heard years of claims that the replacement would be even better. Even more people would be coverage. The coverage would be better. The deductibles would be lower – even though a key element of GOP health insurance policy is that deductibles should be higher. Whatever, that’s coming apart now, now that we’re in the crunch. And we’re hearing talk of coverage replaced by ‘access’. ‘Access’ is the eatability of famine policy studies. There’s plenty of food to eat, as long as you have money to buy it. Access rather than food.

So long as we don’t have a universal system such as exists in various permutations in virtually every other wealthy industrialized country, the only real measure of policy success or failure is the number of people who have health care coverage – not theoretical access to coverage, coverage

The number of people with usable insurance is the only measure that counts. “Access” is bullshit. I’m sorry to put it in such a raw fashion but that is the fact. The number of people who lose their insurance is the only legitimate measure. And it doesn’t really matter whether they lose their care in 2017 or 2020. That’s just political gamesmanship.

This is the reality. The real issue is access to quality medical care. In our system, you only have true access to medical care when you have a health insurance policy. Access to health insurance is a meaningless concept. Coverage is all that matters. [italics Marshall; bold me]

Yep.  Fortunately, though, I don’t think too many people are actually fooled by Republican sophistry on this.  We shall definitely see.

About Steve Greene
Professor of Political Science at NC State

8 Responses to Cutting to the chase on health care

  1. Jeremy Tarone says:

    Lets not forget, the ACA was based on a Republican idea. They loved it, until someone tried to implement it. What Republicans have shown, time and time again is they aren’t interested in giving as many Americans as possible health care. They just pretend.

    • rgbact says:

      “The number of people with healthcare is all that counts”? No wonder liberals are so out of touch. Most voters want lower costs……which this guy admits isn’t a big priority

      This guy clearly hasn’t read the studies on how Medicaid does little to improve health outcomes. And the VA has issues. So sorry…..theres other things that matter besides “coverage”

      • Jon K says:

        Could you please point out these studies that show medicaid doesn’t improve health outcomes. I think that you just made that up.

        There have been plenty of reports about states like Kentucky that have seen huge public health benefits from expanded medicaid.

      • rgbact says:

        Theres various studies. One in Oregon, one in Virginia that I can recall. Then the VA fiasco. Enough to question the “coverage is all that matters in healthcare” model this guy is advocating. Nevermind the huge costs that he totally ignores…..which is mindblowing on its own.

      • Steve Greene says:

        For the record I’m all for bringing costs down. Best evidence from literally dozens of modern economies is that the best way to this is through more government regulation, not “free market” reforms. Also, VA has had very attention-getting problems, but whole story is far more complicated.

      • Jon K says:

        This statement from the Georgetown article Dr Greene posted sums it up:
        The only people I’ve ever met drowning in medical debt were those with pre-Affordable Care Act bare bones health “plans” and those without coverage at all.

        Facts are stubborn things. It is a fact that a quality health insurance plan for an individual costs about $5,000 per year. The only way a lower income person can afford to buy a quality health insurance product is if they receive help absorbing that cost.

        For someone living on $25,000 a year that $5,000 represents 20% of their yearly income. If we expect that 30% of pay is going to rent, then you can see that without help those two items would consume half of that person’s income. That’s why subsidies are a necessity if we want working class people to be able to receive medical treatment.

      • Jeremy Tarone says:

        Please quote exactly what text I wrote even implies: “Most voters want lower costs……which this guy admits isn’t a big priority”.
        I guess it’s easy to think you’ve got a point when you just make stuff up.

        Perhaps you haven’t heard the news, the US spends more than any other country on healthcare while not providing care to a large and significant portion it’s people.
        Having the most expensive care that only gets to a portion of the people makes American health care even more expensive per capita.

        20 percent of American cancer patients can’t afford treatment.
        “It is a big surprise that 20 percent of people with health insurance can’t afford to have the cancer therapy they need to save their lives,” said John Seffrin of the American Cancer Society.

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