Peter Jacobson, for Georgetown Law’s O’Neill Institute Health Reform blog, writes:
We face both a moral crisis and a cost crisis and we can’t seem to navigate both simultaneously. As between the two, Congress should expand coverage and worry about costs later. If the absence of cost controls, which do not appear to be adequate in any of the pending bills, results in no legislation being enacted, it will be a tragedy. If the legislation expands coverage without adequate cost controls, it will be a policy problem to be rectified in subsequent legislation, but hardly a tragedy.
* * *
For those individuals and families without adequate health insurance, there is no brutal choice between costs and access; there is only the brutal reality of what happens when they need medical care and can’t afford it. * * * I’m sick of the distraction that bending the cost curve has become. To paraphrase Keyshawn Johnson, just pass the damn bill.
Photo by stephanebenito.
That captures the moral force of the argument for providing health security before cost reform. (Although, as I mentioned before, I think the current legislation is actually quite ambitious with respect to payment and delivery-system reforms.) There’s also a strong pragmatic consideration.
We have to settle some big questions about the structure of the healthcare system before we can know how best to allocate our resources within it, and before we can know what tools we have are at our disposal. It wouldn’t make sense to invest a lot in fine-tuning the preferences or settings on your computer just before you switch to a new operating system. Or—because every policy debate should at some point be reduced to a hypothetical about pizza toppings: it wouldn’t be prudent to order 10 double meat-eor pizzas with carnivore crust for your party before you even know basic facts like how many people are coming, if any are vegetarians, and whether someone can bring extra lipitor and defibrillators.
Reform of the payment and delivery systems is a complicated and largely experimental endeavor, but providing for health security is comparatively simple. Until we get everyone in “the system,” our efforts to fix it are likely to be inefficient and the benefit of those efforts maldistributed.