Brill shot back, telling Will: “You’re completely wrong. We have tried that experiment with 30 to 50 million Americans who don’t have health insurance and have to pay 100 percent right now. They have no choice. They are powerless consumers.” When an ER doctor says you need a CT scan, he pointed out, you don’t sit around and wonder if you really need it. Or if this is an efficient emergency room.
Strassel threw in her two cents: A large group of Americans get their healthcare from employers, she said, and they have no “skin-in-the game.” In other words, they need to pay more for their care because if they do, they won’t use as much, and the price will drop. She noted there’s no price transparency, no ability to look around, the way we do when “we spend hours deciding which toaster we’re going to buy,” Strassel said.
Brill countered: “There’s a difference between buying a toaster and buying a CT scan.”
On Medicare again: Rattner returned to Medicare, arguing that when people go on Medicare, they really don’t see price, so “they tend to consume more [healthcare services] than they otherwise would.”
Some questioning from Stephanopoulos might have helped make this part of the conversation more factual. That Medicare beneficiaries overuse healthcare is a common rationale for cutting the program, as well as the amount of coverage they currently get from a Medigap policy. Not everyone agrees. Late last year, the National Association of Insurance Commissioners told Kathleen Sebelius, the Health and Human Services Secretary, that after analyzing studies in peer-reviewed journals the association found no evidence that seniors were using more healthcare services when they were fully reimbursed for them.
Rattner shifted to end-of-life costs —“really tough, moral questions,” he said. Strassel brought up rationing, a recurrent subject in healthcare’s verbal wars. (Never mind that it was somewhat off topic.) “Are you going to let consumers make those choices about end-of-life decisions, or are you going to have Medicare” tell you “about what procedures you can have, and how much they’ll pay, and government make those choices?” she asked.
Brill took the position of the little guy, saying that in the real world most people don’t have the money to make the “wise” healthcare decisions ABC’s other roundtable guests—presumably well paid for their work—can make.
Stephanopoulos allowed Will the last word, and he seemed to argue for high deductible health insurance: “No one expects automobile insurance to cover your windshield wipers. Insurance is for large unpredictable events.” In other words, the less coverage the better. Never mind how much you have to pay out of pocket. As Brill reports in his Time story, those out of pocket payments easily reach a sum that is out of reach for most families. (The Rand corporation, in a 2011 study, came to the conclusion that people with high deductibles use fewer healthcare services, which in turn raises the question of whether such people are using their money efficiently— or merely shortchanging their health.)
Stephanopoulos could have done a better job steering the conversation, and his producers might have done more homework. Still, Brill’s bright performance managed to make some important points that large segments of the public have not heard before on a national news outlet. He managed to pierce the fog of out-of-touch Beltway commentary we hear much too often.
The Second Opinion, CJR’s healthcare desk, is part of our United States Project on the coverage of politics and policy. Follow @USProjectCJR for more posts from this author and the rest of the United States Project team. And follow Trudy Lieberman @Trudy_Lieberman.