- NC Policy Watch - https://ncpolicywatch.com -

We should reject simplistic health care solutions

Here's a simple concept with profound implications: our health care system is complicated.

Opponents of reform make hay about the size of Congressional bills to fix the health care system. They cut commercials that scare seniors. And industry-funded groups carpet bomb our email accounts with malicious lies about various provisions included in Congressional health care bills. This is all made possible because a complex system requires a complex fix. There's no way around it.

Take preexisting conditions. Everyone agrees that we should not allow insurance companies to deny coverage or charge someone $3,000 per month in premiums because of the person's health history. That's not fair.

But if we require insurance companies to accept everyone then we must require that everyone purchase insurance. Otherwise, you can wait until you have cancer or heart disease before buying a policy. If we require everyone to buy insurance we must also provide subsidies to those who can't afford coverage. A change here requires a tweak there and the pages start adding up. And as the pages add up so do the opportunities for opponents to make mischief.

Another problem with complex legislation is that opponents can offer talking point alternatives that sound seductively simple. And that is exactly what conservatives are offering to counter the meaningful proposals offered almost exclusively by progressives.

The two most common talking points from conservatives are that we should just focus on wellness and prevention and that we should contain costs with tort reform. Let's look at each of these simple points.

Wellness and prevention are important. Current proposals address wellness by eliminating co-pays and deductibles for recommended screenings, vaccines, and well-baby visits. Conservative senators and representatives have called for more aggressive use of prevention to cut costs. Conservative health care bills in Congress, including legislation co-sponsored by Sen. Richard Burr, project major savings from wellness initiatives. But there just isn't much evidence to support Burr's wishful estimates.

The Congressional Budget Office summed it up neatly in a letter sent to Congress on August 7: "Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."

Conservatives have spent years complaining that tort reform is a prerequisite for controlling health care costs. But, again, the evidence isn't there to support the malpractice reform claim. Much like prevention, there may be good reasons to reform our tort system, but it will not likely cut costs.

It's been demonstrated time and again that large jury awards and malpractice insurance costs are a small fraction of health care spending. So conservatives now argue that the fear of getting sued leads to unnecessary tests, which drive up health care spending. But a 2006 Congressional Budget Office report surveyed the literature on defensive medicine and made its own calculations and concluded that tort reform probably won't lead to big savings.

And Texas has some of the strictest tort reform laws in the nation and it also has some of the most inefficient health care and some of the highest rates of over testing.

Wellness and prevention are critical, and there are good arguments for why we need to reform our medical malpractice system. But conservative arguments that wellness and tort reform will save us are platitudes meant to score political points and confuse the public. That brings me back to my first point: our health care system is complicated. Anyone promoting a quick fix is selling snake oil.

Adam Linker is a Policy Analyst at the North Carolina Health Access Coalition [1]