Nothing Simple About Fixing U.S. Health System

People don't want a complicated health care reform bill. They want something simple. That's the received wisdom from pundits on the left and the right.

It's easy to understand why. Our lives are complicated enough already.

Psychologists say our instinctive preference for simple ideas over more complex ones influences what we buy, how we invest and even the people we find attractive. It influences our political choices, too.

Just one problem: The U.S. health care system isn't simple; it's mind-numbingly complex. So are the problems that beset it.

Americans spent $2.5 trillion on health care last year. A new study, published in the journal Health Affairs, estimates that we'll spend $4.5 trillion in 2019 unless changes are made.

That's what the nation will spend on care. But what does it mean to you, personally? It's simple: For every dollar you spent on health care last year, you'll spend $1.44 in 2019.

Meeting with Post-Dispatch editors and writers last Friday, Republican Sen. Christopher "Kit" Bond of Missouri offered a simple health care fix: Let's allow health insurance companies to sell policies across state lines. That way, someone in St. Louis could take advantage of cheap rates offered by an insurance company in, say, Texas.

Does it sound good to you? It must to Democrats, because it's at the heart of health care reform bills already approved in the House and Senate — the same bills that congressional Republicans, including Mr. Bond, have been consistently attacking for almost a year.

In the Democratic bills, the marketplace for interstate sales is called an "insurance exchange," and it comes with some built-in consumer protections.

But even though the insurance would be provided by private companies, Mr.

Bond is adamantly opposed to what he described as a "government takeover" of health insurance.

"I really think this over-spending and over-control will kill the private health insurance industry," he explained.

Here's another simple idea that's gaining traction with congressional Republicans: Require health insurance companies to cover everyone without respect to past medical history.

Like insurance exchanges, that's already in the Democratic health reform bills. But Republicans object to another component in the health care reform bills: A requirement that everyone obtain health insurance.

That so-called individual mandate has prompted Republican lawmakers in nearly two dozen states to introduce bills that they hope would override the requirement.

Most experts say those state efforts wouldn't pass constitutional muster because of the federal supremacy clause. But what would happen if they did?

Economists have a simple term to describe the result. They call it an "insurance death spiral."

Without a mandate to buy insurance, people could wait until they got sick to get coverage. But insurers couldn't take the illness of their new customers into account when setting premiums.

Under those circumstances, why would a person who isn't already sick buy insurance? He wouldn't.

The simple solution is to require everyone to get coverage. That means helping the many American families who don't earn enough to buy a health insurance on their own.

What are you left with when it's done? A bill like those that have already passed in the House and the Senate. And a choice.

We can pass something simple. Or we can enact reforms that address the very real — and very complex — health care problems we face.

But we can't do both.

REPRINTED FROM THE ST. LOUIS POST-DISPATCH.

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