Healthcare Mythology

The end is near. The dizzying debate over healthcare that has left us in a nauseous national malaise is ending. So says the president. If he has his way, the most transformative social reform of our lifetime will be enacted by the time we recover from spring break.

The White House hopes that by setting a “finish line” that is within reach, lawmakers will rediscover the sense of urgency they’ve lost. “We are very close” to the end of “our journey,” announced the president Saturday. “Now is the time!” he exhorted. (Apparently even more so than the last time that was also “the time.”) We must finish this, the line goes, if for no reason other than we are so close to finishing. One more step, and we can solve this crisis. Or, in the words of this newspaper’s Monday staff editorial, “solve a pressing national issue.”

If only.

Language heralding a grand finale may be good politics, but it’s dangerously delusional. Passing the bill will hardly solve a “pressing national issue” and will be no ultimate solution. More precisely, it may give cause for short term celebration, but it will only help create the next great American crisis.

Now healthcare reform, if enacted, will certainly do some much needed things. But to cast the vote as the end of the problem, as a crisis averted, is wishful thinking at best. We should know better.

Why? Because it’s an entitlement. Mandate health insurance for all, and the government is obligated to provide it for those who cannot—no matter the cost. And in the long term, no matter how laudable a goal, that will prove disastrous.

The President says the bill is paid for and so we shouldn’t worry. The Congressional Budget Office agrees—provided the Congress of 2018 is as willing as the Congress of 2010 to tax health plans in 2018 and provided that those much-maligned insurance company profits remain sufficiently high that taxing them yields ample government revenue to fund the very programs meant to keep those companies in check.

But that’s the short term. The problem with entitlements is never in the short term. It comes later, when future legislators feel generous, when programs expand beyond their original intent, and when past commitments exceed present budgets.

Remember: At its inception Medicare was solvent, financed by a tax simple enough that President Johnson explained it at the bill’s signing. Social Security was intended to save us from the very kind of fiscal catastrophe toward which it is driving us. The State Children’s Health Insurance Program served children. Medicaid covered far fewer patients than it will post-reform, and most doctors actually accepted the coverage.

Today Medicare and Medicaid expenditures represent five percent of our GDP. In 2035, they will represent 10 percent and by 2080, 17 percent. We will spend 20 percent more on Social Security in 2035 than we do today. And we already cannot afford it.

Oh, here I go, just another Republican harping on the debt to be obstructionist. No. This is not a criticism of the plan’s provisions—even if criticism is warranted. This is not a justification for inaction. This is about something more fundamental: It is a critique of what we think the healthcare bill represents—or doesn’t. Already committed to billions of dollars of debt-creating entitlements, we are on the verge of committing ourselves to billions more, assuring ourselves that it will be okay because somehow this time it will be different.

We just don’t care. We have developed a certain collective apathy for this mounting debt. As threatening as the Social Security-Medicare-Medicaid triumvirate is, we’ve heard about it so much that we shrug it off and turn to a crisis that is much more interesting. (This is why if you’re still reading this you’re either my mother, avoiding a midterm, or so despondent from not being placed in Kirkland that you refuse to join in on Housing Day festivities.) After all, in Credit Card Nation, a new purchase is much more thrilling than paying off last year’s spending.

But won’t the bill’s promised savings to individuals make a difference? Unlikely. At the all-for-naught Healthcare Summit, an aid had to correct the president that, yes, a CBO projection shows premiums will be forced up for some. The website for the President’s proposal explains that individuals who have employer coverage will “likely” see lower premiums. For a bill that’s been sold on the premise of affordability, one would like some more certainty. And to cover their bases, they add: “And remember, the cost of doing nothing is high. In 10 years, healthcare spending for each employee at an average big company will be $28,530.” Translation: Just in case we’re wrong, remember we’re damned if we do, damned if we don’t. Comforting, right?

Yes, healthcare reform is a noble cause. In the short term, it may even cut some costs. But no matter what the president says, passing a bill ends no “journey.” It won’t “solve a pressing national issue.” Odds are it will make one worse. And we must be honest enough with ourselves to see that.

Mark A. Isaacson ’11 is a government concentrator in Kirkland House. His column appears on alternate Thursdays.