Can you have one without the other?

By Liam Day
July 21st, 2008

Reading Alan Sager’s and Deborah Socolar’s op-ed in the Globe this morning, I was reminded yet again how the dualistic view of the health care debate in this country is wrong. It simply can’t be an either/or proposition - either access or cost containment. As the authors point out about Massachusetts’ new universal health care legislation:

The law’s proponents underestimated costs and overestimated revenue. Redeeming the law’s promises has therefore obliged the state to spend more to subsidize insurance. This obligation imposes unsustainable financial and political stresses amid a growing budget deficit. Many health reform advocates therefore now declare cost controls crucial to the law’s survival.

Of course, in reality you can have access without cost containment, but politically the drive for universal access will ultimately be undermined by escalating costs. And, conversely, you can always contain costs by restricting access to the healthy, wealthy and wise, but that, too, is politically unpalatable to a lot of people (myself included).

I don’t know what the solution is (Sager and Socolar recommend pushing as much fiduciary responsibility as possible down to doctors, whom they claim control as much as 90% of health care spending), but I do know this: discussing universal access in a vacuum is a political non-starter.