HEALTH CARE/Joan Retsinas

Hogwash Health Policy

Hogwash! Thank you, Vice-President Cheney, for re-introducing an old-fashioned word that conveys, with no hint of obscenity, the worth of a belief. Like "baloney," "hogwash" connotes preposterousness: only an idiot would believe it. Of course, I think your assertion that American troops are winning the hearts and minds of Iraqis is "hogwash;" but hogwash, like truth in this administration, may lie in the eyes of the speaker.

In the health care arena, this administration has given us a few pearls.

Hogwash #1: Tax deductions for health insurance will spur a major swathe of the uninsured to sign up. This is the president's promise.

A major swathe of the uninsured don't pay taxes -&endash; their incomes are too low. Or they don't earn enough to take deductions. When the president leaves the Oval Office to greet constituents at black-tie dinners, he should wander into the kitchen, ask the staff who has health insurance (family, not just individual), who works part-time, who has been hired just for this shindig. He should ask about their children, their partners, their friends &endash; are they covered? How? Would an insurance deduction matter?

Hogwash #2: Too many people have luxury insurance policies. Capping the tax-deductions for health insurance will encourage more people to buy cheaper policies. Cheaper will be good for enrollees, good for the country.

This administration equates health insurance with housing, or cars. As wealth rises, buyers' proclivity for luxury rises; but both McMansions and subsidized apartments offer the basics: a roof, central heating, indoor plumbing. So too a Lexus and a Civic offer the basics of an internal combustion vehicle. Cheap insurance policies don't offer the basics: some don't cover catastrophic expenses; others don't cover preventive care; still others have such high deductibles and co-payments that the enrollees sometimes find them useless. Yet sicker people need the better coverage &endash; and sicker people are more likely to be poorer than healthier people.

Hogwash #3 (a corollary of Hogwash #2): Patients are consumers who should shop for the best prices in medical care &endash; just as people shop for the best prices in everything else. The current system doesn't encourage shopping. One way to lower overall costs is to turn us all into Internet surfers, stalking the best bargain.

Some procedures do lend themselves to comparison-shopping (Lasik surgery, for instance); but health care decisions are complicated. A coronary bypass operation is not the same as a Disney World vacation; a ventilator is not the same as a computer. Patients, particularly sick ones, rely on their physicians for guidance. Besides, most patients are not looking for the best (or, in the beloved jargon of economists, the most cost-effective) bargain, but for the best care. Nobody will accept death, or a restricted, painful life, just to lower the national health care tab.

Hogwash #4: People want insurance enough to pay a major chunk of their income for it. Making insurance "affordable" will spur more people to sign up.

States will be testing this axiom. Will a person who earns $30,000 a year pay $3,000 a year for health insurance? Would he pay $2,000, assuming that subsidies could bring the cost down that low? The president should query the same wait-staff about their budgets. How much discretionary income do they have, after paying for housing, food, child-care, and transportation? Would they spend it on health insurance? Ironically, young, healthy people might understandably say "no;" yet without young healthy people in the pool, the premium costs per enrollee will soar.

Researchers have been pointing out the flaws in these optimistic market-driven predictions for years. If the country wants universal health insurance coverage &endash; a questionable "if" &endash; the country must embrace a compulsory, tax-subsidized program. That chimera may end up looking like a Medicare extension, or an enhanced state-operated Children's Health Insurance Program, or some hybrid. Fiddling with the tax code, or making individual enrollees into insurance-shoppers, will not suffice. Just about everybody outside the Oval Office recognizes this. Maybe even the administration knows this. And maybe the administration gives credence to these flawed pearls only to placate its conservative constituent-base.

If so, the ultimate hogwash is that the Administration believes its own hogwash.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, March 15, 2007

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