An Escherian Dilemma: Health Insurance Access or Health Care Cost?

Access to health insurance is an important problem, as is evident from one insurer's recent announcement that it would raise premiums by up to 39 percent. Improving access to insurance seems to have been the main focus of most health care reform legislation to date, but there is more to the story. According to the insurer that is proposing to raise its rates, the cost of medical equipment and services is the reason behind its proposed premium hike.

Given the dramatic increase in health care expenditures over the last several years, there is no doubt that limiting the growth rate of medical expenditures is extremely important to do. To see why, just take a look at some of the scariest sites on the internet: The Congressional Budget Office's Health page, and the Centers for Medicare and Medicaid Services National Health Expenditure Data page.

If you are not familiar with the CBO, it does some impressive and eye-opening work. If you are at all interested in how the government is proposing to spend your money, take some time to review the CBO's site. The site includes a number of interesting documents relating to health reform efforts, and CBO (thankfully) has the freedom to demystify some of the more confusing language. For example, in one analysis, the CBO notes that the Senate's health reform bill would actually increase the deficit, while nominally preserving the solvency of the "Health Insurance" (that is, Medicare Part A) "trust fund" that has been projected to be bankrupt by 2017.

So, which should be addressed first, access to insurance or the cost of health care itself? Like almost everything involving paying for health care, the only clear and simple answer is that there is no clear and simple answer: This is a chicken that hatches out of its own egg. Are there any M.C. Escher devotees who want to try their hand at drawing that?

(On another note, here are some interesting additional perspectives on what it would mean to repeal the antitrust exemption for health insurers. Although most of the experts in that article suggest that repealing the exemption would have little, if any effect on the health insurance market, there is only one surefire way to find out what it would do....)

© 2010 Alex M. Hendler. All Rights Reserved.

Brobdingnagian, Leviathan, or just plain enormous?

It is hard to pick an adjective to describe the (finally) published version of the Senate's amended health care bill, a.k.a. H.R. 3590.EAS. For a bill that started off as a few paragraphs to extend the first-time home buyer's tax credit to certain overseas members of the military, it has—in line with one of my earlier predictions—morphed into a beast that weighs in at about 2.4 kilopages (2,407, to be exact, not counting two superfluous pages at the end). I have not yet had a chance to read it, but with the election of Scott Brown to the late Senator Kennedy's seat in the Senate, it would probably not be the best use of time, the general consensus being that his election limits the likelihood that the Senate's version of the bill would survive unscathed a conference with the House.

That said, below are some potentially interesting statistics on the bill that the Senate passed (much of it based on automated analysis):

• Size

As a plain text file, it is about 2.5 MB;

The official PDF of the bill is about 4.3 MB;*

The table of contents is 16 pages long;

The bill is approximately 16,000 lines long;

It contains approximately 379,638 words.

• Complexity

It has 441 Sections of its own;

It adds 173 new Sections to existing law;

I doubt there is any religious significance, but that amounts to 614 sections altogether (one more than the number of commandments commonly held to exist in the Hebrew Bible), a fact that might be interesting to certain factions that oppose this legislation;

It makes approximately 912 amendments to existing law;

It mentions the "Social Security Act" 706 times;

It mentions the "Public Health Service Act" 284 times;

It mentions the "Internal Revenue Code" 195 times;

It mentions the "Employee Retirement Income Security Act" (also known as ERISA) 25 times.

• Money

It contains 360 dollar signs;

It mentions numbers in unrounded millions (i.e., xxx,000,000) approximately 206 times;

It mentions numbers in billions rounded to millions (i.e., xxx,xxx,000,000) approximately 39 times;

Of those 39 times, it mentions numbers in unrounded billions (i.e., xxx,000,000,000) approximately 26 times.

What is the point of reporting all these numbers? Merely to point out that the bill is big, complicated, and addresses numbers of a size more typical of biology, chemistry, physics, and CMBS balance sheets. Why is is so big and complicated?

Unfortunately, the straightforward solutions to the problem of securing universal health insurance coverage (i.e., mandate individual insurance purchases through imposition of a new income tax, refunded in part through vouchers to pay for such insurance, in part to subsidize insurance for those who could not otherwise afford it; get rid of preexisting condition exclusions; completely remove the federal antitrust exception for health insurance), are, for the most part, political non-starters.

While some of the complexity in health reform legislation may stem from earmarks or other concessions to bring certain legislators on board, I submit that a larger part comes from attempting to reach the same results as above in such convoluted—sorry, "creative"—ways that politicians can try to explain their way around the outcome in a manner that would allow them to get reelected.

There are some hints of what a "pared-down", passable bill might do, and while it could be a start, if that is what Congress ultimately does, it is still quite far from where we need to be, i.e., universal (but not necessarily unified, i.e., "single payer") coverage.

So, is Scott Brown's election a good or a bad thing for "health reform"? With that, I leave you to Federalist No. 10 and your own conclusions:

A zeal for different opinions concerning religion, concerning government, and many other points, as well of speculation as of practice; an attachment to different leaders ambitiously contending for pre-eminence and power; or to persons of other descriptions whose fortunes have been interesting to the human passions, have, in turn, divided mankind into parties, inflamed them with mutual animosity, and rendered them much more disposed to vex and oppress each other than to co-operate for their common good.

*Your numbers may differ; my operating system reports sizes in megabytes as if 1 MB = 1000KB; some systems reports sizes as if 1MB = 1024KB; technically, the latter definition is called a "MebiByte", but few people actually use that term.

© 2010 Alex M. Hendler. All Rights Reserved.