Hiding health care costs defeats reform

The basic Medicare premium will shoot up by $110.50, or 15 percent, next year, government officials sternly announced on Monday, because the cost of health care continues to skyrocket even though the cost of living is declining as other prices fall.
But they were just kidding.
Law shields Social Security pensioners from what goes on in the economy and doesn’t allow the Medicare premium to rise any faster than the Social Security pension does, no matter how fast health care costs rise.
Because the cost of living didn’t rise, there will be no COLA for Social Security pensioners and they will not be charged the additional Medicare premiums.
That doesn’t apply to all. New retirees will pay the higher premium. So will those whose income is above $214,000 for a single or $428,000 for a couple. And the states will be stuck with the higher premium for those whose premiums are paid through Medicaid programs.
Wait, there’s more. Chances are 99-1 that nobody will pay the additional $110 a month. That’s because the House of Representatives has passed a bill canceling the increase and Kansas’ own Kathleen Sebelius, now secretary of Health and Human Services, urged the Senate to do likewise. “The last thing seniors need right now is a substantial increase in their Medicare premiums,” she explained.

AND THE LAST thing the country needs right now, Mrs. Secretary, is to turn a blind eye to the rising cost of health care, which is exactly what refusing to require seniors to bear their share of that increase does.
Out-of-control health care costs — America pays almost twice as much for health care for every one of us than any other wealthy nation does — is what is driving the demand for top-to-bottom reform of the system.
But that demand flags when those costs are hidden.
Health care reform that brings costs down will require moving away from fee-for-service payments that encourage providers to over-test and over-treat. Compulsory, universal insurance that brings the young and healthy into the system will also be necessary. These are root-and-branch changes that are being resisted mightily by those who stand to lose when the money flow narrows.
Those imperatives won’t happen unless those who will benefit from lower health care costs are informed and then seek to serve their own best interests by acting. The most effective way of informing the very large majority of Americans who would benefit from lower health care costs is to find ways to make more of us pay for a bigger percentage of those costs from our own pockets.
Because health insurance comes through employment for a majority, the cost is less visible. And it is because those premiums went through the roof, causing many employers to increase deductibles, ask employees to pay a bigger share or dropped the benefit altogether, that a promise of health care reform helped elect Barack Obama and a Democratic Congress.
Taxing so-called Cadillac plans is one way to discourage overuse. Eliminating the business deduction for health insurance premiums, as John McCain proposed in his presidential campaign, would soon sever the connection between jobs and health insurance and recruit millions to the reform bandwagon.
All of these steps would help America take its blinders off and look the cost of our health care system straight in the eye — which may have to happen before effective reform becomes possible.

— Emerson Lynn, jr.