The May 14 issue of the New England Journal of Medicine contains an article, Picking the Right Poison — Options for Funding Health Care Reform, that sets a new tone for the journal. It looks at health care reform through a clear lens. Funding universal health care is going to cost a lot of money. Be assured that whatever the estimate of its cost now is, its true cost will be many multiples of whatever number is currently presented.
Jonathan Oberlander the author of the perspective piece rightly concludes that health care reform cannot pay for itself by making the system more efficient. Rather expansion of coverage will generate additional costs. Raising taxes seems inevitable, hence picking the right poison. This choice usually means taxing someone else.
Reducing benefits is another option. This, of course, will be presented as getting rid of fat. One man’s meat is another man’s fat. Oberlander’s statement, “There is, then, no easy way to pay for comprehensive health care reform,” may get him thrown out of the club of right thinking analysts for whom nothing good is hard.
He compounds his truth telling by adding that “reformers may have to retreat from the goal of providing all Americans with comprehensive insurance.” That such a radical approach to healthcare reform made it into the NEJM suggests that hard reality may be intruding on good intention, that intent and outcome are not the same.
Remember the immortal words of Russell Long, Huey’s boy, “Don’t tax you, don’t tax me, tax that guy behind the tree.”