Er, no. Despite all the screaming about the uninsured, uncompensated health care is only roughly 3% of total health care system spending, an expected overhead level that hasn’t changed much in years. A much greater market cost-shifting effect comes from the under-market reimbursement rates of Medicare and Medicaid.

Not that most health care providers wouldn’t like to get that 3% compensated, but it’s not gonna cut systemic costs other than temporarily and minorly at best. That overhead is already there–putting new money into the system will by definition NOT reduce system costs. And once those people are in the system as compensated, their utilization of services will increase, also raising system costs.

THE major cost driver in excess systemic healthcare cost growth (excess is “over rate of GDP growth”) is purely and simply advancing technology. New tech costs more than old tech, especially when you’re tha nation that pays the development costs. This applies in all developed economies. Even Great Britain has the same cost growth trend for the very same reason, if not necessarily to the same degree. Even when another nation (us!) bears the brunt of the cost of developing the new tech, in effect subsidizing it for everyone else, it still costs more.

The only way to control that major cost growth driver is through rationing of new tech, which perversely also slows the initial development of new tech and its evolution to cheaper levels of implementation.

There are indeed some systemic efficiencies in our healthcare system that could be gained in various ways, but once the one-time savings from achieving them are absorbed, cost growth will merrily resume unless new tech is rationed. Just as it has in every other developed nation.

You go first, Justin. When is a liberal going to tire of printing cash for more useless projects like studying pig flatulance?

First, let me be clear that I’m saying that there will not be any significant “cost cutting” due to reform. I am not sayig that US healthcare doesn’t cost more than some other nation’s healthcare. Oh, there will be a few trims here and there, but there is no way to provide health insurance to 40 million people who do not have it now without a huge increase in the total cost, which will be paid for by somebody (the issue is by whom) or result in less care for somebody. To say, oh, don’t worry, we’ll cut costs is transparently a dodge.

Second, since you brought up the favorable comparisons to European and other state-run systems, with the usual stats about them, let me point out just a few flaws in this line of argument:

– “We are ranked 42nd worldwide in life expectancy. ” That’s the single most cited stat (from the CDC). But the fact is that US life expectancy is lower than other affluent developed countries almost entirely because of the high rates of death by accidents and homicide (which are unheard of in Europe and Japan). Tragically, those non-natural events are the leading causes of death among American under 45. When you adjust the stats by taking out those non-natural causes, US life expectancy is first among the industrialized OECD nations. First! It’s dishonest to cite this life expectancy stat as if it bore a one-to-one relationship to health care.

– We pay a lot more per capita than other nations. True, but again, statistics can be very misleading. If you adjust the per capita health care spending to compare it to per capita GDP — thus, accounting for overall higher salaries and other costs in our system — you find that GDP differences account for 35-40% of the higher US health costs.

What about the other 60%? No question, costs are still higher. But that can be attributed to a host of factors, including three conspicously big ones:

(1) Doctors and hospitals in the US practice defensive medicine because of our tort system and epidemic litigation (which simply does not exist in Europe or Japan).

(2) There are well-documented differences in American culture that lead to higher incidence of illness, particularly obesity and alcoholism. These are a problem with people who have very good health care plans, as well as those covered by Medicaid and those who have no coverage. There may be ways to get people to change their lifestyles, but the access to health care alone is not a solution.

(3) The US system supports in various ways the lion’s share of the expensive development of medical technologies and drugs and a good part of the positive changes in treatment and practice, which are then copied by other systems. One can argue whether doctors, hospitals, universities, drug companies, biotech firms, etc,. should be compensated as royally as they are for all this, but one should not lose sight of where the money is going or why.

“This whole “cost cutting” meme is just a way to spin the healthcare reform so it’s more palatable than Hillary care was. There won’t be any less costs; there will hugely increased costs to provide quality care to millions of people who don’t have it now.”

It is an accepted fact the US health care system has a poor cost-to-benefit ratio. We have the highest expenditure of 15.1 % of GDP yet 40 million lack insurance, 30 million underinsured and all of these statistics are rising rapidly. We are ranked 42nd worldwide in life expectancy. There are more that one study that ranks our medical care low in industrialized nations. The fact is there are other countries who have 100% coverage at a fraction of the cost with higher life expectancy. Do I believe it’s as simple as that? No, there are issues with any health coverage plan. But the basis for your argument is that it is impossible for increased medical care without sacrifice. You extrapolate the current model without consideration for potential alternatives. This country suffers from the “not invented here” syndrome.

Anyway, back to the original post — Buckley is a rube, as is all the self-proclaimed conservatives that backed Obama. Obama is doing what he said he was going to do in the primaries. We shouldn’t be surprised that he’s a liberal from Chicago, because, well, during the primaries, he said he was.

DUH.

What are they? About 45 million individuals (give or take; the numbers vary) don’t have health care coverage. However, millions of them are illegal aliens or young people who don’t choose to buy or pay for health care coverage. Sorry, I’m not for paying taxes to cover them.

I wholeheartedly back a program that would ensure coverage to people who lose their jobs, people who work for employers that don’t offer coverage, and young people who want coverage but have passed the magic age of 19 for their parents plans to include them.

But let’s not kid each other that such expanded coverage to tens of millions of people won’t cost somebody money and will even save money!

“Also, you ignore the notion that getting everybody into the healthcare system will ultimately cut costs, and every single serious medical organization agrees with that idea.”

Please, which “serious medical organizations” are they? The same medical organizations that provide the services that have become so costly? Doctors through the AMA? Hospitals and their legions of PR people and lobbyists? Healthcare employee unions?

The only way to cut costs enough to notice is either to reduce currently available care for some people, or pay less money to the ultimate beneficiaries (docs, non-profit hospital execs who earn multi-million-dollar salaries, investors in for-profit hospitals and other care facilities, device makers, drug makers, and insurance companies, and oh, the federal and state governments that sop up billions already.)

This whole “cost cutting” meme is just a way to spin the healthcare reform so it’s more palatable than Hillary care was. There won’t be any less costs; there will hugely increased costs to provide quality care to millions of people who don’t have it now. That’s the whole point, isn’t it! Either that, or care will be cut or rationed or both.

In any case, my starting point for this entire issue is different. For 20 years or so, we’ve heard the constant lament about health care costs eating up 6% of GDP, then 8% of GDP, then 10% and now more. And the costs are rising faster than inflation. My answer to that is, so what? As we grow richer (and we have been and will continue to be), and as more and fancier ways to stay alive and well have come along, we collectively have decided that we’d like to have more health care. No one would care a fig if we decided we wanted to have more cars or houses or vacations instead. Those would be signs of our affluence. But more health care? No, can’t have that, even if the entire health care industry is a major source of economic growth as well as a benefit to our health.

The real issue in health care reform is this: we all want more but who is going to pay for it. How much do I pay; how much does my employer pay; how much do taxpayers pay.

It’s only when the question is framed honestly in that way that we can have a debate about it that doesn’t degenerate into spin, foolishness or deception.

Also, you ignore the notion that getting everybody into the healthcare system will ultimately cut costs, and every single serious medical organization agrees with that idea. They’ve run the numbers. They know. And they also acknowledge that costs can’t keep going up 3 times the rate of inflation every year. Something must be done about it, and doing it now rather than later is a smart move because it’ll be so much more if we just allow the problems to continue to fester.

The Obama proposals that many of us object to are not those designed expressly to provide fiscal stumulus, Keynes-style, to “pump prime” the economy. His proposals extend far beyond that, as Buckley properly noted, to encompass trillion dollar deficits (or much higher taxes than so far acknowledged) for the next decade, even if the recession ends later this year or early in 2010 (as most economists and analysts, including those in the CBO, Fed and IMF all believe it will).

Really, if you want people to leave their “economic ideology” at the door, you must also contend with the obvious fact that Obama’s programs are not just “Keynesian” and not just aimed at shortening and mitigating the current recession.

Way too many variables. Way too much to argue about. Too many folks of various ideological stripes, all eager to declare that they were right. Too much skill at showing how any given outcome is proof that your PoV is the way to go.

I predict that people keep showing up where they belong, and that we keep muddling along. And that politicians keep taking credit for the good things and blaming the other party for the bad things. Wish I could bet real money on that.