National Working Group Examines Health Care Tradeoffs in Public Forum at HMS

Americans can have good care, comprehensive care, or inexpensive care, but they cannot have all three, according to the Citizens’ Health Care Working Group at a public forum held Aug. 16 in the New Research Building.

When it comes to improving the health care system, the most difficult question is about tradeoffs. “We need to make some tough choices,” said working group member Richard Frank, the Margaret T. Morris professor of health economics at HMS.

Frank is one of 14 citizens from diverse backgrounds who were selected to represent an informed cross-section of the American people to develop recommendations for the President and Congress for “health care that works for all Americans,” according to the legislative mandate. The group is barnstorming the country to learn about specific regional health care issues. They aim to issue a preliminary fact-finding report in October, followed by a year of town meetings to solicit public input. More information and a webcast of the forum can be found at www.citizenshealthcare.gov.

If current trends continue, health care will eat up about one third of the nation’s income by the time today’s 45-year-olds celebrate their 70th birthdays, Frank said.

Historically, individual income grew with health care costs, so higher insurance premiums did not cut into other purchases. That is now changing, Frank said. Not only is consumer spending threatened, the greater federal health care budget will force voters and politicians to choose among larger deficits, tax increases, or big cuts in other government services.

Another tradeoff is that “lower-risk people have to be willing to subsidize higher-risk people,” said working group member Catherine McLaughlin, professor of health management and policy at the University of Michigan School of Public Health. Now, some of the uninsured are “the young invincibles,” young adults who judge themselves at low risk of health problems and choose to spend money on other priorities than health care.

On the other hand, providing insurance to the uninsured may not be as costly as some people believe, McLaughlin said. For example, at any given time, there may be as many as 63 million people uninsured for several months, but as few as 10 million uninsured for one full year. The usual estimate of uninsured people in this country is 45 million.

As many as one quarter of the uninsured people are elderly. Children and Hispanics account for another large proportion. Many uninsured people try to save money by postponing cost-effective preventive health care or treatment of injuries.

When it came time for public comments, several members in the sparse audience disagreed with the notion of tradeoffs as framed by the working group.

“Talk of tradeoffs infuriates me,” said Ann Malone, a health care advocate with the Ad Hoc Committee to Defend Health Care in Boston, who received the loudest applause of the forum. “Excuse me, but we already pay more than enough if we have a mandate that health care dollars go to health care. Thirty-nine cents of every health care dollar in this state goes to administration.”

—Carol Cruzan Morton

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