YahooFinance is reporting Upfront costs complicate Obama’s health care plan.

Costs are emerging as the biggest obstacle to President Barack Obama’s ambitious plan to provide health insurance for everybody.

The upfront tab could reach $1.2 trillion to $1.5 trillion over 10 years, while expected savings from wringing waste and inefficiency from the health care system may take longer to show.

Details of the health legislation have not been written, but the broad outlines of the overhaul are known. Economists and other experts say the $634 billion that Obama’s budget sets aside for health care will pay perhaps half the cost.

The U.S. spends about $2.5 trillion a year on health care, more than any other advanced country. Experts estimate that at least one-third of that spending goes for services that provide little or no benefit to patients. So theoretically, there’s enough money in the system to cover everybody, including an estimated 50 million uninsured.

In the campaign, Obama opposed tampering with tax-free employer-based health care, saying it would undermine the system that delivers coverage to most people. Other prominent Democrats agree. Asked if he would support taxing benefits, Rep. Charles Rangel, D-N.Y., the top tax-writer in the House, simply said: “No way!”

Baucus says doing away with the tax break altogether would cause harm, but some limitations might curb waste in the system. Obama’s aides say he’s still opposed, but willing to consider any serious proposals from Congress.

Obama’s opposition to taxing employer-provided health insurance isn’t the only campaign position he might have to jettison to pay for health care.

He once criticized his chief Democratic presidential rival, Hillary Rodham Clinton, for proposing that everyone in the U.S. be required to have medical insurance. Yet such a mandate probably will be in what Congress puts together because requiring individuals to pay would lower federal costs.

For Obama, there are no easy ways to pay for health care. Options include raising other taxes, cutting deeply into Medicare payments to providers, or phasing in the expansion of coverage for the uninsured — beyond his four-year term.

Healthcare Costs and U.S. Competitiveness

Inquiring minds are reading Healthcare Costs and U.S. Competitiveness.

The United States spends over $1.9 trillion annually on healthcare expenses, more than any other industrialized country. Researchers at Johns Hopkins Medical School estimate the United States spends 44 percent more per capita than Switzerland, the country with the second highest expenditures, and 134 percent more than the median for member states of the Organization for Economic Cooperation and Development (OECD).

The United States spent 16 percent of its GDP in 2007 on health care, higher than any other developed nation. The nonpartisan Congressional Budget Office (CBO) estimates that number will rise to 25 percent by 2025 without changes to federal law.

These ballooning dollar figures place a heavy burden on companies doing business in the United States and can put them at a substantial competitive disadvantage in the international marketplace. For large multinational corporations, footing healthcare costs presents an enormous expense. General Motors, for instance, covers more than 1.1 million employees and former employees, and the company says it spent roughly $5.6 billion on healthcare expenses in 2006. GM says healthcare costs add between $1,500 and $2,000 to the sticker price of every automobile it makes. Health benefits for unionized auto workers became a central issue derailing the 2008 congressional push to provide a financial bailout to GM and its ailing Detroit rival, Chrysler.

Rival Healthcare Models

Elsewhere in the world, healthcare systems are much less reliant on private sector support–and much less expensive. For example, the U.S. system costs 83 percent more per capita than the Canadian system, where public funds collected through taxes pay for up to 70 percent of healthcare coverage.

The ‘Triple Tax’

By and large, companies do not argue against the employer-based insurance model. Rather, they contend that a wasteful public-private system is pushing costs much higher than they should be. Jeffrey Rideout, a medical doctor and the head of the Internet Business Solutions Group at Cisco Systems’ Healthcare Practice, says the amount businesses pay for employee insurance is just one element of their total healthcare costs. Rideout says businesses incur a “triple tax.” First, they pay for insurance programs through health benefits. Second, he says, businesses indirectly subsidize Medicare and Medicaid, the federally supported programs for primarily poor and elderly Americans. Businesses pay higher insurance premiums to make up for the fact that Medicare and Medicaid reimbursements often do not match the total costs hospitals incur treating these patients, a “hidden tax” confronted in a health care proposal (PDF) laid out by California’s Governor Arnold Schwarzenegger. Third, Rideout says, businesses also subsidize the strain on the system wrought by the cost of treating America’s uninsured, again through higher insurance premiums.

Obama does not propose to alter the employer-based system and move to a single-payer, government-run system. Instead, he wants to allow people and small businesses, who currently have trouble affording health insurance, to buy into a government-sponsored insurance pool similar to the one for insuring U.S. federal employees.

Improving Value

Healthcare experts agree the people with the most control over what drugs get prescribed and what procedures get done have little incentive to lower these costs (indeed, to the extent that they get paid by the procedure, their incentives are often quite the opposite). Likewise, patients often feel little need to control the costs of their own medical care if it is covered by insurance. The system bears the brunt of the excess, and employers make up the difference in the rates they pay.

Experts say that 1/3 of what we spend is wasted. Given the US spends 44% more per capita than Switzerland (the second most expensive nation) and 83 percent more per capita than Canada my guess is we are wasting between 50 and 75% of what we spend.

The US has problems with prescription drug costs (we subsidize the rest or the world), extraordinary high administrative costs, an incentive to over-prescribe drugs and tests for incentive reasons as described above and also for legal reasons (malpractice). Finally, the amount of healthcare expenses spent in the last year or so of people’s lives (often against their will), is staggering.

So Obama has a plan, and that plan is an estimated 50%, $634 billion in the hole at the outset (the estimated amount over 10 years). However, government programs are always much more expensive implemented than proposed. Therefore, a more resaonable estimate of costs might be 2-5 times greater than proposed. And even if by some miracle the costs come in as expected, the world’s most expensive healthcare system is about to get much more expensive.

This is not a plan, it’s a nightmare.

Mike “Mish” Shedlock
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