In a recent POLITICO op-ed, former Comptroller General David Walker cuts to the chase on an extremely important, but forgotten, point in the health care reform debate:
“[T]he law does not come close to dealing with the long-term fiscal challenges caused by rising health care costs. It may have increased coverage, but you can’t increase coverage and save money—that’s an oxymoron.”
What happened to the conversation over costs?
Along the way to last week’s Supreme Court ruling, the cost issue got lost. Correct some of us for appearing somewhat ignorant while attempting to insert a bit of pragmatism and sanity in the discussion: didn’t the debate kick off because most of us were worried about costs?
Mom, pop, cousin, auntie, uncle and grandmom all twisted themselves into sky-is-falling contortions and projections about the rising cost of health care. It was 9% of Gross Domestic Product in 1980 – now, it’s 20% and rising. We’ve got the fastest growing health care spend rates in the world, with per capita spending near $3,000. Everyone at the time was complaining about expensive procedures, wallet-breaking MRIs and unnecessary surgery. Doctors were right down there in hell with lawyers, lobbyists and meter maids. Remember all that? The medical profession, from hospitals to surgeons down to dentists and the specialists, were all in on one big, costly national hustle. The sicker you were, the more money your physician could make.
My own grandmother summed it all up on the way to a check-up: “On my way to the doctors to find out what else is wrong with me so they can make more money.”
Enter new president who staked his legacy, depleted all political capital and pretty much any concerted focus on job growth to attack the health care spending gremlin. It was all about how unsustainable the system had become, how horrifically expensive it was for not only the people who needed it, but for the country expected to pay for it. It was the new Internet bubble of the 21st century cracking at the seams.
Talks, panels and conversations drumming up new ideas about how to contain costs seemed plentiful at the time. But, it’s all blowing away like dust on ancient texts. Some health policy experts look stupefied at the mention of containing costs through streamlined health administration; others get defensive when you bring up a nationalized system of digitized record-keeping and virtual delivery. Not exactly sure what happened to standardizing the cost of health care procedures – perhaps even capping how much health professionals can charge consumers.
Doctors skipped away like bandits on this point. It’s no longer a direct debate about the cost of the actual health care services. Now it’s more like a conversation about the cost of the law – which The Washington Post contends is only 0.49% of GDP. And, much like other policy proposals brewing in Washington these days, that exact point seemed completely lost and tossed in partisan salad.
It’s a bit like watching lawmakers celebrate the passage of legislation preventing a catastrophic doubling of student loan interest rates. That was better than stand-up. What’s there to celebrate? Ultimately, it’s about the exorbitant cost of college tuition and how it’s ballooned into a class caste-system firewall steadily keeping certain segments of the population locked out of the “American dream.” The average cost of a 4-year post-secondary institution in 1980 was $8,700 – today, it’s over $33,000 … and rising.
Keeping the lid on interest rates might slow down the hemorrhage and buy a struggling post-grad a bit more time to enter an economy barely mending itself. Yet, that misses the point. If college tuition weren’t so high in the first place, we wouldn’t be having that conversation, right? And what’s so radical or revolutionary about expecting a bit of relief from colleges who keep raising tuition?
Really: I’m not arguing for or against the Affordable Care Act. Nor am I offering any real position on student loans or finding consensus on how much we should pay each month for debt that shouldn’t be there to begin with. I’m just a bit stumped on why the reason legislation is created, deliberated and exhausted is not the main point of it anymore. That’s much of the problem on Capitol Hill these days, contributing to the dysfunction of an institution that acts functional through its marble grandeur. By the time the debate is done, or at least one major phase of it, lawmakers either forget or don’t want to recall what they were arguing about. The solution gets lost in the scuttle of constant coal shoveling, tall-tales delivered to a public quite satisfied with being misinformed and unaware.
So, go ahead and enjoy your temporary interest rate reduction. That sure does a lot for our kids, who will look to broke parents to help pay college costs that will end up being more than double what we’re paying now. But, just like 8% unemployment, you won’t mind adjusting to the new normal.