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Tallon: Lawmakers face health-care tests

It’s not just a numbers game, but the future of health care in the United States does center on two big questions, according to James Tallon.

Speaking at the 10th Binghamton Symposium on Health Care Management and Policy sponsored by the School of Management on Oct. 17, Tallon asked if the United States  is “capable of having an intelligent conversation about a complicated issue, and able to do anything about it?”

President of the United Hospital Fund of New York, chair of the Commonwealth Fund and chair of the Kaiser Commission on Medicaid, Tallon said that framing the health-care debate is a challenge and far bigger than simply talking about how we will do Medicaid, Medicare and the like.

Tallon said the U.S. spends twice as much and 50 percent more as a share of GDP on insurance than any of a dozen other industrialized countries, and those trend lines are growing.

“It is not only that we are well north of all of the other industrialized countries and have the gap in coverage,” he said, “but the difference is growing and the data are very powerful. It’s an issue of national economic security.” 

The U.S. health-care system, however, works exactly as it is designed.

“We sell health care as capitalists and purchase it as very organized socialists,” Tallon said. “Every component of our health-care economy that provides services has a positive incentive to increase price or volume, or both.”

Tallon said there are four tests for legislators to overcome in agreeing on health-care legislation.

First, will uninsured people be able to purchase a valuable insurance product at a price they can afford?

The second test to overcome is a radical provision in the proposed bill that would effectively eliminate welfare through a radical restructuring of Medicaid to create a national standard of eligibility at roughly $25,000 level of income  — about 40 percent of the whole bill.

Thirdly, can Congress find a way to pay for the bill? And the fourth test: cost.

“Essentially, there is both the desire that we should be thinner and healthier, but some would suggest that trying to tie that into this insurance debate is a very dangerous thing to do,” he said. “We have to put forth a societal effort, but should be wary of tying it into an insurance bill.”

With the ultimate goal to get insurance for the uninsured, we must figure the cost-control side and come up with the money to pay for it, Tallon said, cautioning that the president won’t sign a bill over a trillion dollars.

“We may get some savings through being more efficient administratively,” he said. “It’s more complicated on the delivery side, but there is growing evidence that says better coordination at the primary care level could achieve some savings.

“We will have to create a new era of health-care coverage and we have to change the conversation. If the real threat is about coverage and cost, we have to figure out the mechanisms for discussion,” he said, and all parties have to be part of the discussion.
“In no other Western industrialized country do health-care costs lead to bankruptcy. That’s the kernel of truth in this country. We link economic security to health care. We’re in deep trouble and we need some help with this bill.”

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Last Updated: 10/14/08