Impulsive legislation now, cost considerations later

As the national debate on health care reform gains speed, everybody's looking at Massachusetts' experiment in mandated health insurance. From today's Boston Globe there's an article titled "Costs snarling health overhaul – Study finds more are struggling to pay; gains at risk in state's foray into insurance." Here's a telling passage:

While the state is facing cost challenges, he said, implementation of near-universal coverage in 2006 still put consumers here in a better position than in other states. "We should be lucky enough to have those problems [nationally]," Altman said of the challenges outlined in the Urban Institute survey. "If we get to a point where everyone is insured, then we can move on to worry about the affordability of care."

We're not buying a wedding cake here. We're talking about irreversible federal legislation that will dramatically alter how one-sixth of the economy operates. The only issue worth consideration is how to pay for national health care before we indulge in self-congratulation. As usual, the curse of "good intentions" is leading the debate towards the easy work of expanding coverage before considering the costs involved. It's dessert before dinner.

All this, of course is lost on Ted Kennedy who has an opinion piece in today's Globe with five principles of health care reform, only one of which is related to the cost. Predictably, the old chestnuts of "fraud, abuse, and red tape" are rolled out. Let's be honest: fraud and abuse have been around since shipbuilders supplied the Greeks with boats for the Battle of Salamis. New data technologies may help but the main drivers of rising health care costs are an aging population and advanced medical technologies. The irony that Ted Kennedy fails to grasp is that the very technology that has helped him to battle brain cancer would be unavailable for most Americans under a national health care program, no matter how much he wishes otherwise.