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54
NOV / DEC 2013
I
Healthcare Journal of New orleans
This old saying has been popular around leg-
islatures everywhere for a couple of centu-
ries, but it now has particular relevance after
witnessing the activities of Congress this fall.
I would add, however, that the quote does a
disservice to sausage-making, which is much
less disgusting then the performance of our
elected lawmakers in Washington.
I can’t recall such drama since the Cuban
Missile Crisis in 1962. How did it happen? As
usual these days, health reform really makes
some people crazy and that’s exactly what
transpired. OnOctober 1
st
the insurancemar-
ketplaces (aka exchanges) were scheduled to
go online so that eligible persons could com-
pare and select health insurance plans. But the
federal website that serves more than half the
states had unexpected problems, rendering
enrollment impossible in most states.
We have to remember that the federal gov-
ernment expectedmost states to take the reins
in establishing the exchanges, but instead 36
out of 50 states decided to let the feds do it
all. In Louisiana, the Department of Insur-
ance expressed its willingness to take on the
task of building a statewide exchange until the
governor announced his opposition. To no-
body’s surprise, most states that constructed
their own site find that it works better than
the federal website, which turned out to be
a huge fiasco.
Even so, there is still no excuse for Health-
Care.gov to have failed like it did. IfACAimple-
mentation follows the pattern of the exchange
debacle, the Tea Party won’t have to lift a fin-
ger to get rid of ObamaCare.
Keep in mind that all this heated rhetoric
stems from a federal law that was passed by
Congress in 2010 and has been found to be
constitutional by the U.S. Supreme Court.
It’s hard to believe that something like 40
House members (out of 435) can threaten
to bring down the government in order to
make their point.
Complexity of U.S. Healthcare
Recent policy columns have dealt with sys-
temic problems that drive up the cost of the
U.S. healthcare system. Readers may remem-
ber the following list of excess costs estimated
by the Institute of Medicine for a single year,
2009: unnecessary services, $210 billion; inef-
ficiently delivered services, $130 billion; excess
Congressional Effort to Derail ObamaCare
Threatens World Economy
policy
I
David W. Hood
“There are two things you don’t want to
watch being made: laws and sausages.”
administrative costs, $190 billion; prices that
are too high, $105 billion; missed prevention
opportunities, $55 billion; and fraud, $75 bil-
lion. The tab totals $765 billion for just one
year. But it mounts up: over a 10-year span
the total (not counting inflation) would be $7.7
trillion, almost half of the national debt. Here’s
how the IOM report describes the enormity
of the problem for a single year of healthcare
overspending:
At this level, unnecessary health care costs and
waste exceed the 2009 budget for the Depart-
ment ofDefensebymore than$100billion (OMB,
2010). Health care waste also amounts tomore
than 1.5 times the nation’s total infrastructure
investment in 2004, including roads, railroads,
aviation, drinking water, telecommunications,
and other structures. To put these estimates in
the context of health care expenditures, the es-
timated redirected funds could provide health
insurance coverage for more than 150 million
workers (including bothemployer andemployee
contributions), whichexceeds the 2009 civilian
labor force.And the total projectedamounts could
pay the salaries of all of thenation’sfirst response
personnel, including firefighters, police officers,
and emergency medical technicians, for more
than 12 years.
According to latest Congressional Budget
Office estimates, the coverage provisions
of the Affordable Care Act over the next ten
years will total $1.3 trillion. Therefore, redi-
recting just a fraction of the excess costs listed
above could easily finance the annual amount
needed to cover the uninsured (no new taxes
needed, thank you). So, whatever else we do,
let’s make sure we reduce as much of that
waste as we can. But part of the problem is
that theAffordable CareAct is missing global
– Origin disputed