Is anyone else as sick as I am of hearing the wonky phrase ”bending the cost curve” as a proxy for why we need to enact health reform legislation? I’m all for including cost controls in whatever legislation emerges from Congress. But the primary policy goal for me remains the moral imperative of covering those who lack insurance, especially those who are not young and invulnerable, such as recently unemployed auto workers in Michigan.
We face both a moral crisis and a cost crisis and we can’t seem to navigate both simultaneously. As between the two, Congress should expand coverage and worry about costs later. If the absence of cost controls, which do not appear to be adequate in any of the pending bills, results in no legislation being enacted, it will be a tragedy. If the legislation expands coverage without adequate cost controls, it will be a policy problem to be rectified in subsequent legislation, but hardly a tragedy.
Look at it this way. Legislation with no or inadequate cost containment that emerges will not discernibly reduce health care costs any more than if Congress is unable to enact any legislation. We all know that the status quo will result in higher costs and lower benefits over time, and will mean that millions more will have no or inadequate insurance coverage.
David Brooks, writing in the New York Times on 24 November 2009 makes much the same point in arguing that the debate is about values. But his conclusion is strongly on the “moral preference” of controlling costs (primarily, it seems, to protect future generations against crippling deficits—certainly a legitimate concern). In response, an eloquent letter published in the Times on Thanksgiving day appropriately argues that Mr. Brooks gets the values equation exactly backward. Robert S. Nussbaum asks, “…how can he [David Brooks] call a decision on whether to provide care for those in the greatest of need a ‘brutal choice’?…We know that failure to pass health care legislation means certain death to some who go without proper care.”
Writing in the New York Review of Books, Tony Judt provides an appropriate contemporary context for the juxtaposition of moral and economic considerations. In an essay titled “What is Living and What is Dea in Social Democracy?” (17 December 2009, page 86), Judt observes that:
“For the last thirty years, in much of the English-speaking world…, when asking ourselves whether we support a proposal or initiative, we have not asked, is it good or bad? Instead we inquire: Is it efficient? Is it productive? Would it benefit gross domestic product? Will it contribute to growth? This propensity to avoid moral considerations, to restrict ourselves to issues of profit and loss–economic questions in the narrowest sense–is not an instinctive human condition. It is an acquired taste.”
Sure, we need to reduce costs—it would be foolish to argue that cost controls are irrelevant. At the same time, advocates of expanded coverage for uninsured and underinsured populations will lose every time the debate revolves around “bending the cost curve.”* Most Americans don’t have a clue what that phrase means and need to be reassured that they won’t “live in fear of losing their” health insurance, as another Times letter writer, Rolf Sjogren, wrote in response to David Brooks.
For those individuals and families without adequate health insurance, there is no brutal choice between costs and access; there is only the brutal reality of what happens when they need medical care and can’t afford it. As a statement of our society’s moral values, no person in this country should be forced to sacrifice or postpone medical treatment for lack of health insurance. Nothing else even comes close. I’m sick of the distraction that bending the cost curve has become. To paraphrase Keyshawn Johnson, just pass the damn bill.
*As an aside, note that in opposing welfare benefits in the 1980s and 1990s, conservatives effectively combined economic and moral arguments to support the need for reform. At the time, I felt that the moral arguments were persuasive in shaping public attitudes.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.