Incrementalism at its best

Last night I spoke as part of a panel on health care reform.  The main point I tried to get across was that our health care system is a mess.  It’s the costliest in the world, it gets nowhere near universal coverage, and it is surprisingly disappointing in terms of quality.  This is not news to readers of this blog.  Because it’s so bad, we need real reform.  Massive.  It needs to be big and it needs to be comprehensive.

If you listen to politicians on both sides of the aisle, you’d think we were getting that.  Those on the right claim this is a total government takeover of health care the likes of which have been seen only in their worst socialist nightmares.  Those on the left claim it’s going to revolutionize the system by covering everyone, reducing costs, and realigning the delivery system so that we get quality over quantity.

Not so much.  On either side.

I’m reading over the CBO report for the new and improved Senate Finance Committee bill.  Here’s an actual projection on how the bill will change insurance coverage over the next ten years:

Change (+/-) in millions of nonelderly people
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Medicaid/CHIP
*
-2
-2
-1
6
10
13
13
14
14
Employer
*
2
2
3
4
*
-2
-2
-3
-3
Nongroup/Other
*
*
*
*
-3
-4
-4
-4
-5
-5
Exchanges
0
0
0
4
15
22
21
22
23
23
Uninsured
*
-1
-1
-6
-22
-27
-28
-29
-29
-29

Here’s what I want you to notice.  See the Employer line?  There are currently about 150 million people who have employer based insurance.  This plan will, after a decade, result in a net three million fewer people on employer based insurance.  We will expand Medicaid and SCHIP by 14 million.  We’ll get 23 million people into the insurance exchange.

The number of uninsured will drop 29 million, leaving another 25 million people under the age of 65 still uninsured.

This is socialism? This is comprehensive, massive reform?  Hah! Don’t get me wrong.  This is still a good thing; 29 million fewer uninsured people is better.  I imagine that the tighter regulations will help prevent underinsurance as well.

But let’s not kid ourselves.  A lot of those newly insured are getting coverage from safety net programs.  And the rest are going into the exchange to buy private insurance.  There is no massive government takeover.  Nor, however, is this comprehensive reform.  We will only have reduced uninsurance by about half and will still have more uninsured people than any comparable country.  Or costs will still be massive and rising fast.  And our quality will still likely hover around where it is now.

Yes, this is the most that any administration has ever gotten in terms of health care reform for the country at large.  But is this is really the best we can do?

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