There is nothing on the table now that can cover the uninsured and keep taxpayer costs reasonable. What would it take? First two key facts. About 25 % of Medicaid and Medicare funds are spent in the last year of recipients' lives. Second, the clever medical researchers will continue to invent ever more costly technologies and drugs to increase life a few more months or years. The nation must face the tradeoff between the ideal and what we want to spend. The only way that we can improve the care of those whose only option now is hospital emergency rooms is to insure them for basic medical care-- no open heart surgery, etc.
Senator Kennedy was diagnosed with cancer, and even with the best of treatment, his life was extended only a few months at a cost of hundreds of thousands of dollars. Those dollars could have paid the annual health insurance for 47 million uninsured.
There could be a list of medical procedures that simply are not available at public expense, such as is now operative in Oregon. The slogan-makers who obfuscate the unavoidable tradeoffs will throw smoke on this suggestion railing about making the the poor and uninsured second class citizens, but of course they are third class now and since few want to pay substantially more in taxes, they will remain such. Here, the unobtainable ideal is the enemy of substantial improvement. It would be nice for everyone to have the latest technology and drugs to extend their lives for a few more months. But, few including seniors during their tax-paying years want to pay for it. And, they know there is no end to ever more costly medical wonders.
Setting aside the scare words of “death panels,” these are the tradeoffs that could improve care for many and not break the bank. A public option that might reduce insurance administrative costs is a good idea, but the bitter debate over it is diverting attention from more essential tradeoffs.
If Obama is to make good on his promise to keep spending near present levels, then he must cap medicare and medicaid spending and divide the pie differently. Cover more people at reduced, less grandiose levels.