President Obama's speech to a joint session of Congress tomorrow night -- I'll be staying late and live-blogging for Orange Punch -- is an admission of near-defeat. It's not a matter of a poor message but of a growing recognition that there's just no way to extend health insurance coverage to 47 million more people and reduce the overall cost. Ordinarily, when government gets involved in something it doesn't bring costs down but increases them, and that's the way it's been with health care since Medicare was passed in 1965. The more government involvement the higher the costs. So in a recession we want to commit to another trillion (over 10 years) that will undoubtedly turn out to be a lowball figure? A lot of Americans just aren't buying it.
To complicate matters for The One, various government entities keep coming up with quasi-realistic cost estimates that give the lie to the preposterous notion that more government will mean less cost. As this Register editorial explains, the Congressional Budget Office determined that electromic record-keeping, while not necessarily a bad idea, wouldn't save an appreciable amount of money. And now a group studying preventive care for diabetics has determined that while (again) it's not a bad idea at all, it will cost more money over 10 years, and the only patients for whom a lifetime saving can be predicted are those diagnosed between ages 24-30, and only after about 25 years.
The core problem is third-party payment, which means consumers have no incentive to look for better, lower-cost care or procedures. I know it goes against the grain, but the best approach is to re-establish the tie between paying for medical services and the consumer of services.