The Health Affairs Journal held a press conference/policy briefing last week in Washington, DC to illuminate some of the issues involved in health care reform and separate out fact from fiction. I listened to about half of it, and can assure you the speakers were well-informed and to the point. You might want to download the Powerpoints or listen to the podcasts if you are worried that health care reform will mean more government control over health care.

Here are some key things I took away:

1. People who are employed and earning two times the Federal Poverty Level ($35,000/yr) would have to pay $12,000 or 36% of their incomes for health insurance were they to purchase a family plan. No wonder it’s the “working poor” who form the bulk of the uninsured. We used to call them the “notch group”; they are the people who fall between those who have employer-based insurance and those who have Medicaid or some similar government plan. Clearly, either the Federal Poverty Level has to be re-calculated, or these people must be subsidized.
2. 22% of America’s health insurance costs are now paid by Medicare, and 17% by Medicaid. Private health insurance is bigger than either of those, but not as big as the two combined.
3. Creating free markets for private insurers has been tried by the HMO Act, which handed control of health insurance to the states, and again by the Medicare Modernization Act of 2003, which created both the prescription drug plan and Medicare Advantage plans. These programs, designed to create competition and lower costs, have not lowered anything.
4. The government spends money on health care that has nothing to do with health insurance:
   for public research and dissemination of information about health it funds the National Institutes of Health ($30B); the Agency for Health Research and Quality ($372m), $50m for comparative effectiveness studies, $ 9B for the Center for Disease Control, $1.4B for terrorism, $1.9B infectious diseases– and $20B for Health Information Infrastructure.
5. Any reform will mean a bigger role for government, but we don’t know how yet.

By the time I got finished listening, I was convinced that the real debate was about the role of government in a free economy, not about health care at all. And it might also be about why we all think we deserve everything for nothing, and whether that’s sustainable.

Once again, sign up for the discussion on The R Word (Rationing) on Sept. 25.