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Health Care Debate Should Focus On Spending

Armen Hareyan's picture

"We need to have a candid debate about health care in 2008, but theodds are against it," as presidential candidates have focused on theissue of the uninsured, rather than "runaway health spending" because"expanding benefits is so much more politically rewarding than tryingto control them," Washington Postcolumnist Robert Samuelson writes. Health care spending, which totalsmore than $2 trillion annually, accounts for 16% of gross domesticproduct and could account for more than 25% of GDP by 2030, Samuelsonwrites.

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According to Samuelson, the "unchecked rise in healthspending" likely will "increase taxes, depress take-home pay and crowdout other government spending," but "our national policy toward theseissues is: Don't ask, don't tell." The "politics of health care restson a mass illusion," as most U.S. residents "think that someone elsepays for their care," he writes, adding, "No one has an interest incontrolling spending because everyone believes that it burdens someoneelse." Samuelson writes that U.S. residents "need to see and feelhealth costs."

Samuelson recommends an increase incontributions from Medicare beneficiaries, the establishment of a"dedicated federal health tax" that covers all health care spending bythe federal government and increases as costs increase, and thereplacement of the "income tax exclusion for employer-paid insurance"with a "tax credit of lesser value." The proposals would allow for adebate on "how big the government's role should be" in health care, hewrites, adding, "Don't hold your breath" because these "would inflict'pain,' and candidates who embrace them would invite political ruin."

Samuelsonwrites, "Health care is ultimately a political issue of makingchoices," but the "present politics aims to camouflage the costs andskew the choices," adding, "Until we change that, our debate will leadto dead ends" (Samuelson, Washington Post, 12/6).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily HealthPolicy Report is published for kaisernetwork.org, a free service of The HenryJ. Kaiser Family Foundation.