Health care is expensive. No one is going to make it cheap. If there’s one lesson that Americans might learn from the Affordable Care Act debacle, maybe it’s that one. But as they absorb that hard truth, they might become susceptible to believing a subtler lie than “if you like your plan, you can keep it.” Free marketers, conservatives, Republicans all need to be aware of that peril.
But first, let’s look at the premise for the ACA. It’s in its name: Affordable Care Act. If you asked most Americans what they consider affordable, chances are the answers won’t mesh with the true costs of care, especially care for serious and/or chronic conditions.
Take cancer care, for example. A cancer patient might spend two or three nights (maybe more) in the hospital for surgery. That stay alone involves dozens of highly trained staffers seeing to the patient’s care. I doubt a single American would begrudge good nurses or nurse’s aides a decent salary and benefits package. Add to that the cost of high tech equipment, ancillary services and overhead and the other treatments and drugs that might follow. Then look at the bill–who could make it “affordable” in the sense of turning those thousands upon thousands of dollars of care into, say, just hundreds of dollars. No one.
Let me repeat that: No one could turn the bill for serious and chronic health conditions from thousands to hundreds of dollars. I’m talking to you, free-market conservatives, as well as starry-eyed liberals. While liberals believe that fixes such as those contained in the ACA will do the trick, conservatives fall victim to their own wishful thinking. They believe that introducing more marketplace pressures into the health care arena will lower costs, added with strategies such as tort reform, leading to “affordable” care.
But here’s the problem with that approach–health care isn’t like other free markets. You don’t spend time shopping around when you face an emergency health care situation. And even with the introduction of more free market approaches that work for non-emergency situations (such as health savings accounts, tort reform, and the like — all of which I support), you’re not going to take that ten-thousand-dollar bill and turn it into a hundred-dollar invoice.
To see the truth in this, just go back to a time when third-party payers weren’t distorting the health care marketplace. You don’t need to go far–try the 1930s. Look at a condition such as polio, which required enormous resources as the patient went from hospital to rehabilitation center to lifelong maintenance. Before health insurance dominated the market, families paid for this care out of pocket. It was still expensive–sell-the-farm expensive. As one father wrote to President Franklin Roosevelt at the time:
“We had a nice little piece of money once, ready to build and furnish and pay cash. Then my boy took sick with infantile and we spent the whole thing, but I never begrudged one penny.”
We live in a time when life expectancy has increased and conditions that once were death sentences are now either curable or maintainable. How blessed we are! Yet, unlike that father writing to President Roosevelt, we do seem to “begrudge” every penny we spend on this vast array of health care options.
Therein lies the peril for free-market reformers. While Americans are learning that not even the so-called “compassionate” party can make health care affordable, they might not yet have realized that getting rid of out-of-pocket costs entirely also has a steep price, too. In other words, single-payer programs will still cost Americans in higher taxes and lower quality of care. But getting rid of the costs Americans currently “begrudge” might mean they’re willing to give that approach a second look.
This presents conservatives with a twofold challenge. They must communicate that single payer still has a price tag to it, and that Americans who don’t like seeing people lose the plans they like under ACA will like even less getting delays and denials from bureaucratic boards who ration care under single-payer systems that will still take money from them in higher taxes.
The second part of the challenge is actually devising a plan that Republicans will rally around, something they can pitch to the American people with the simple message: Health care is expensive, but there is a better way to bring costs down through more transparency, more choice, tort reform, less regulation. If they waste this “teachable moment,” be ready for the next big lie that will sell single payer to Americans. We all know what it will be: If you like your terrific health care, America, you can keep it. It will be no more true than the lie that sold the Affordable Care Act.