Jun. 20--Talk about bad timing for President Barack Obama.
There he was on Monday, exhorting doctors at an American Medical Association confab to join his once-in-a-generation overhaul of health care in America. He drew several standing ovations, even as he told them things that would probably cut their pay.
But then, on the same day, came an astonishing Congressional Budget Office analysis of what all this could cost.
The CBO analyzed the first major health-care proposal introduced, by Sen. Edward Kennedy, and concluded that it would cost more than $1 trillion over 10 years. That sent a jolt of sticker shock through Congress.
But hold on. Here's the kicker to that breathtaking figure: Even after spending all that money, 37 million Americans still wouldn't have health insurance.
Yes, that's a tentative analysis, as the CBO warned. It will change as the bill is fleshed out. And the Kennedy bill is only one of several health-care reform proposals now percolating in Congress.
But the analysis sure seemed to rattle advocacy groups and the White House. "This is not the administration's bill and it's not even the final Senate committee bill," a White House spokesman said.
Ooh, chilly.
So, OK, this is a work in progress, things will change, blah blah blah. But the point here is that the CBO analysis tells us three things that probably won't change, no matter how a major health-care reform law is crafted.
It will be: --Complicated. --Extremely expensive. --Full of unforeseen consequences.
Congress doesn't have to take our word for it. Lawmakers can learn from the experience of Massachusetts, the first state to mandate health insurance coverage.
How are things going there? We'd say it's mixed.
At last count, the Bay State had the lowest rate of uninsured people in the nation, 2.6 percent. That's compared to the national average of 15 percent. Those holdouts are either unwilling to pay for insurance (and willing to incur the penalties assessed by the state) or they can't afford the insurance (even with state subsidies) and aren't required to buy it. Conclusion: Even if coverage is mandated, Congress will have to settle for something less than universal coverage.
Then there's the budget. The state expected to spend $472 million in fiscal 2008 for its health-care plan. The actual cost: $628 million. Budget projections for fiscal 2010 range from $750 million to $880 million. The state is struggling because it underestimated the number of adults who would sign up for subsidized insurance, which under some circumstances covers a family of four that earns up to about $66,000.
Conclusion: Congress has considered subsidizing American families earning up to $110,000 to buy insurance. That would be too broad and too expensive. It appears that lawmakers are moving away from such a commitment.
Beyond the numbers, what about suddenly insured patients who need care? A recent report by the Urban Institute wasn't too reassuring. It found that even those who got health-care coverage in Massachusetts found they couldn't afford needed treatments. It's not clear why.
The sudden influx of the insured has strained the health-care system in the Bay State. Patients report long waits to see doctors. One in five patients has reported being told that a doctor was not accepting new patients, or not accepting patients with their type of insurance, according to the report.
The upshot: People still wound up in emergency rooms for routine care. That undercuts a major premise for covering all Americans, which is to stop them from going to the emergency room for routine care that could be less expensively dispensed in the doctor's office.
Obama wants to push a bill through Congress before the August recess. That deadline may be slipping, thanks in part to this bolt of fiscal reality from the CBO.
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