Back to Work - Bill Clinton [30]
To be fair to the antigovernment advocates, there’s another option: people who don’t buy insurance could be denied any care they couldn’t pay for. On September 12, 2011, in a televised GOP presidential debate, Representative Ron Paul responded to a question from Wolf Blitzer about what happens when people who don’t buy insurance need lifesaving care. He said, “That’s what freedom is all about—taking your own risks.” When Blitzer asked if society “should just let him die,” many members in the crowd cheered. Is this the America you want?
There are better and healthier ways to deal with the problem. If the United States spent 11.8 percent of GDP, the same as France does, on health care, we would save $870 billion a year, money that could go into new investment, new jobs, and pay raises.11
We can’t close the whole gap by moving away from pay-for-procedure to pay-for-performance health care and cutting the excess costs of for-profit insurance companies. We also have to improve our lifestyles to stay healthier. We spend $150 billion each year just to treat diabetes and other conditions related to obesity. A lot of people are working on that, including First Lady Michelle Obama and the Alliance for a Healthier Generation, a partnership between the American Heart Association and my foundation.
If we could close just half the gap between ourselves and our major competitors, it would cut health-care costs about $435 billion a year below what they otherwise would be, and the government’s programs would cost about $140 billion less. We need to work hard on this. Remember, the Simpson-Bowles Commission proposal saves $200 billion over a decade. If we closed just 25 percent of the gap in health-care spending between the United States and other wealthy nations, it would save $700 billion, three and a half times as much.
We have to achieve savings that don’t erode the quality of health care or the living standards of Americans of modest means. For-profit insurance companies, with their obligations to shareholders, and medical providers, with their profits enhanced by the current pay-for-procedure system, don’t have the incentives to do it.
Of course, reform-minded hospitals, non-investor-owned insurance companies, innovative health-care providers, and creative employers can make their own changes, and many are doing so. For example, more and more health-care providers are controlling costs better and improving quality with coordinated care systems. And about 15 percent of U.S. companies with five hundred or more employees have already set up on-site clinics to provide primary and preventive care to employees. They’re finding it increases worker productivity and saves money on health-care costs. But if we want the United States to move as quickly as possible to more cost-effective, higher-quality health care, government will have to lead the charge, offering incentives to providers to lower delivery costs and using its market power to implement reforms that prove to be effective.
The much-derided health-care reform law is already having a positive effect. Aetna has applied to the Connecticut Insurance Department for approval to lower its rates 10 percent because of the law’s requirement that 85 percent of premiums go to pay for health care, not to profits and marketing. In 2012 the price for Medicare