I heard President Obama speak several days ago about his plans for health care legislation. As I recall, he said he was hoping for three things: (1) a reduction in health care costs; (2) an increase in access for people currently uninsured or under-insured; and (3) maintaining choice for people in their selection of doctors and hospitals.
While I admire his goals and hope for the best, I don't see how all three are possible. The Massachusetts experiment with access, i.e., giving insurance to a much broader group, has actually led to higher costs as people use that access for care. Now, over time, this will hopefully level out, as the value of preventative care spreads, but it could be many, many years before that effect is seen.
On the cost front, the president for now seems to be confusing underlying costs with how much the government chooses to pay. His budget proposal apparently would reduce Medicare payments to doctors and hospitals as a way of building a savings account for greater access. Reductions in appropriations might reduce costs to the federal government, but they do not reduce the underlying costs of care. With 50% of American hospitals operating at a deficit right now, it is hard to imagine how a reduction in federal payments for Medicare patients deals with the cost problem. Costs remaining uncompensated by the federal government would simply be spread to other patients.
Finally, other countries that provide universal access usually take away a great degree of consumer choice in doctors and hospitals. Instead, a parallel private insurance system often emerges, outside of the government plan, to provide such choice -- usually to wealthier people.
So, it seems to me that we could accomplish two-thirds of the Presidents goals, but that it would be difficult to obtain all three -- at least in the foreseeable future.