EUA, healthcare reform
A reforma dos cuidados de saúde é actualmente um dos grandes problemas dos EUA. Provavelmente o maior problema. Para quem se interessa por esta matéria, indispensável a leitura do relatório do Council of Economic Advisers, recentemente publicado: “The Economic Case for Healthcare reform” link
Etiquetas: USA health
1 Comments:
How'd this report come about? Who worked on it?
It's actually a nice story. Nancy-Ann DeParle [head of the White House Office on Health Reform] asked if the CEA could do this. And one of the things that struck me was that she said you know, I actually want to know if it's true. If we're going to do this big hard thing, i want to know it's good for the economy. So that was definitely the spirit under which I took on the exercise and did the analysis. And it actually turned out it was good for the economy! We were actually trying to figure out truth, which I think is always a good thing.
How did you settle on the 1.5 percentage points baseline?
You have to be careful because in the report we actually consider three possibilities: 1.5, 1, and 0.5.
And 1.5 is the optimistic one.
Right, even though the industry group said we think we can slow it by 1.5 a year, that's a challenging thing. I was actually at a Brookings event and [health economist] David Cutler said I think you should have done 2. So there's at least someone on the other side.
That gets to my question: Folks seem to have settled on 1.5. The industry groups, you. But how have people settled around that number?
My read in talking to health economists is that 1.5 would be a tremendous accomplishment. Though it may sound like a small number, it's very hard. What moved me today was David Cutler saying that any one thing doesn't look very big because oftentimes you get the synergies when you put things together. They click together to get you something big. And that's why he might be more optimistic.
The analogy he gave was computers. We put them in, saw no productivity increase, then suddenly people figured out how to use them. Oftentimes 10, 15 years after the big change things come together and you see a large productivity increase. So that may be what's in the back of his mind.
Let me ask you the simple question that I think, in some ways, the report is responding to. If health-care reform is going to save us money, why are we talking about raising more than a trillion to pay for it?
There are two things. One is that the kind of things that our report looks at are the changes that slow the rate of growth over the long term. That's the 1.5 percentage points a year.
The trouble is there's a lot of uncertainty about these things. Experts will tell you it's good, but the CBO will say we're uncomfortable scoring it.
What we have done is to say that anything we want to do right now, like the expansion of coverage, we're going to pay for with things you can identify and score, so we know we're not damaging the budget. But we'll also make sure that in that process, we do all these other things to cut costs in the long term.
One of the things our report emphasizes is that the long-run problem is enormous. Even if we didn't expand coverage or do anything else right now, we are on a trajectory for disaster. Look at those projections for 30, 40 years out: A third of GDP is going to health care, the federal budget is in ruin.
Also, we do think the expansion of coverage has some costs now, but we do think it may be part of that slowing of cost growth in the long-term. If you get the wellness programs, more rational kinds of care -- getting people to go to primary physicians rather than emergency rooms -- all of that may help you slow costs. Maybe not immediately. But that's the basic logic.
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