Insurance Overhaul: First Step toward Government Takeover?

As a health futurist and medical economist, I’m not surprised to get questions about implications of the latest reform legislation.  Discussing changes in health care with journalists and industry leaders is part of my job.  However, I am surprised at the question asked most frequently: don’t I think that insurance overhaul is the first step toward a total government take-over of American health care?  I do not think so, for several reasons.

First, if the new laws had been engineered as part of a socialist conspiracy, I believe that I would know about it.  I have good working relationships with a wide-ranging group of politicians, staffers, policy analysts, and lobbyists—people who provide background information for my forecasts on the future of health care.  They are committed to their respective causes, but they are not behind-the-scenes conspirators.  I have not heard the slightest hint of a plan to “take over” health care.  (Indeed, most of my political informers tell me that they wish health care would go away; it’s a no-win issue.)  Even my most liberal sources went no further than pushing a government health plan to compete with private insurance.  Single payer, a goal that would qualify as a step toward government takeover, was not even on the table for serious discussion.  Insurance overhaul’s new thrust, creating state insurance exchanges for private health plans, reinforces the status quo.

Second, the exploding federal deficit shaped every discussion of health reform over the past year.  To pass the overhaul laws, Congressional leaders cut $500 billion from authorized federal spending on health care.  This “solution” shifts payment responsibility to states and consumers at a time when neither has disposable resources to make up the difference.  The economic result is going to be hard times for all.  I simply cannot imagine a scenario where the federal government suddenly has enough money and uncontested power to impose a stable equilibrium on the medical marketplace.  I will rethink this position if anyone can convince me that economic recovery and bipartisanship are just around the corner.        

Third, if insurance overhaul were a planned step toward socialism, the plan would need to reverse the underlying dynamic of health system change in the US.  In reality, American health care is moving toward remarkable diversity, not the one-size-fits-all outcome of a federal policy like No Child Left Behind.  The future of insurance overhaul will play out differently in states and in local marketplaces.  (Indeed, if a government takeover occurs anywhere, it will be at the state level.)  We will see a variety of outcomes in the coming years, many of them quite independent of federal reforms.

Above all, I don’t think the federal government is taking over the medical economy because nobody in the federal power structure has a creative, realistic, and unifying vision of a good health care system.  Today’s political process is preoccupied with trying to fix a broken 20^th century delivery model.  When our political leaders can focus on designing a system attuned to the needs and technologies of the 21^st century, I’ll take the takeover hypothesis seriously.  How about you?