Miles’ Law will likely determine your attitude towards healthcare reform. It states, “Where you stand depends on where you sit.” In other words, we all see things and shape judgments from our own perspectives. How much healthcare reform will cost you will be determined by another law – Richman’s Law – which states, “You can’t get something for nothing.” And it means exactly what it says.
The healthcare debate should be renamed the Political Commentator and Columnist Employment Act of 2009. If you can’t write 60,000 words on this issue, it’s time to find another job. Unfortunately, the subject is so complex that thousands of words can’t cover it; however, using the two laws we can boil it down to the essentials.
Given that the Democrats control both the White House and Congress, there will be healthcare reform, but it still involves enormous political risk. Millions of Americans are dissatisfied with their current healthcare options; but an equal number are generally satisfied. Should the politicians screw this up, the folks who go from satisfied to dissatisfied are unlikely to forget it.
I’m going to forego comments on insurers, businesses, care providers and the how and why we spend what we do on healthcare; I’ll save that for another day. I’ll focus on the customers instead – the healthcare users – and that’s all of us. Users come in two basic flavors, those with heath insurance and those without. Within each flavor, there are two groups, those with good income and/or assets and those without. It’s important to remember that large portions of the population move between the flavors and groups during their lifetime.
If you’re under- or uninsured because of your employment situation, economic or medical condition and you need substantial or regular medical care, you are likely to benefit greatly from the upcoming changes. The primary purpose of any reform proposal will be to cover some of those needs on a direct basis – they are currently covered only indirectly.
Conversely, if you’re well insured or in good health or if you’re in good shape economically, healthcare reform will eventually reduce your coverage or cost you more money, probably both. That is the only way to pay for universal coverage. The truth is that healthcare reform is going to cost a fortune and someone will have to pay for it. Everyone wants that “someone” to be “someone else.”
You’re going to hear all kinds of claims during the debate; there will also be a lot of half-truths and finagling, especially in the area of deferring costs to hide the real pain for several years. As with most large government programs, the costs will greatly exceed the original estimates and the projected savings will not materialize; they almost never do.
If you disagree, I challenge you to name a single large program – and this will be the largest – that is the exception. Medicare has consistently busted its budget or limited its payments while incurring increased costs. All the talk of eliminating waste, fraud and abuse has been just that – all talk.
Over time, these hard facts will force major changes in what healthcare is available, who gets it, how it’s delivered, who pays for it and how much they pay. Some of these changes will be for the better and some will be for the worse, but once we start down this road, the changes are inevitable.
How they will affect you personally will be driven by a complex combination of Miles’ Law and Richman’s Law – where you stand depends on where you sit and you can’t get something for nothing. Keep those two laws in mind as you evaluate the various options and you won’t go very wrong.
Marty Richman is a Hollister resident. His column runs Tuesdays. Reach him at
cw*****@ya***.com
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