“No matter where you fall out on ‘public option (versus) not a public option,’ the thing that our working families need more than anything else is to end these double-digit cost increases that they’re having every single year with health insurance.”
— Sen. Michael Bennet on CNN’s
“State of the Union,” Nov. 22
Yes, that’s certainly what most “working families” would like to see: an end to hefty boosts in their insurance premiums. Unfortunately, they won’t see relief for seven years at a minimum, even with the bill Bennet supports.
Who says? The Congressional Budget Office, in an analysis released this week. And while the CBO is hardly infallible in its forecasts, it at least tries to keep its feet on the ground.
So relief will surely arrive after 2016, you may be thinking, once the full array of cost-containment reforms gathers steam. Perhaps, but I’d keep my hopes in check on that front, too.
As for the early years, the CBO says that under the Senate bill, premiums for employment-based coverage (five-sixths of the market) would be roughly the same in 2016 under current law as they will be if the legislation passes — ranging from 1 percent higher under the bill to 3 percent lower.
For individuals buying coverage on their own, the news is worse: The average premium for “new nongroup policies would be about 10 percent to 13 percent higher in 2016” — except for those with public subsidies. And all of CBO’s estimates could be low, the agency concedes, if it underestimated the growth of health-care spending related to covering those now uninsured.
So what about the longer term? At my request, Bennet’s office kindly identified no fewer than 27 provisions in the Senate bill designed to contain costs or help consumers make intelligent insurance choices. Some measure quality of care and try to tie payments to better results; others promote “value-based purchasing” systems; still others attempt to penalize high-cost hospitals or those that re-admit patients at higher than average rates. One calls for experiments with “innovative payment and delivery arrangements” for Medicare and Medicaid; another tests the idea of “home- based” teams caring for the chronically ill. And several force insurers to disclose more information to consumers, write clearer policies and improve their appeals process.
Will any of this eventually work? Experts don’t agree. But even those who have reportedly hailed the bill’s attempts to reform medical delivery systems tend to hedge their bets when predicting whether the initiatives will collectively succeed without further major reform. Others, meanwhile, see the hoped-for savings as overrated or illusory.
Here’s what is not in dispute: Virtually every one of the reforms represents a bureaucratic fix to rising medical costs as opposed to empowering consumers or entrepreneurs to act in ways that drive costs down.
In his appearance on CNN, Bennet touted the need “to do a much better job of making transparent what things actually cost. No one knows in this country what it really costs to get a knee replacement. No one knows what it costs to get other medical procedures.”
True, but the cost-control provisions won’t even begin to create a genuine market of transparent prices for services. To the extent they enhance transparency, it’s in the insurance market. That’s a good thing, but hardly transformational.
The dean of Harvard Medical School, Jeffrey Flier, predicted recently in the Wall Street Journal that while final legislation will “enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system.”
That’s a worst-case scenario, of course. Given the speculative nature of so many reforms, however, you can see how it might well come to pass.
E-mail Vincent Carroll at vcarroll@denverpost.com.
