The Health Care Version of NIMBY

Health spending growth is often pictured as a dire threat to the United States’ economy and to our federal fiscal health.  Similarly, increasing people’s access to health care insurance is put forth as a crisis which must be solved.  That will cost money.  A variety of cost controls and/or expanded access funding sources have been proposed.  Most are opposed by one or more special interests.  Here are a few recent examples.

Many researchers believe reducing the exclusion from taxation for employer-based health insurance will help reduce spending and would raise revenue that could be used for access expansion.  But unions have sought an exception to protect their often very rich health plans.  Senator Baucus’ bill proposes a tax on medical device makers, who generally have very high profit margins.  Minnesota’s senators, who are advocates for more regulation and control of pharmaceutical manufacturers, are very concerned about these fees and their impact on Minnesota’s device industry.  CMS has proposed a bundled payment for dialysis, including the very profitable drugs used for the treatment.  The drug makers are not happy, and will undoubtedly seek to undo the proposed change, through Congress if necessary.

If we are going to reduce cost growth and fund better insurance access, someone is going pay more or receive less revenues.  It is just that simple.  Our political system, with millions in campaign contributions and a myriad of lobbyists, makes doing that in a rational way very difficult.