Taxing to pay for health care - is it necessary?

The House Democrats have introduced their proposal for health care reform.

The tax raises are minimal at first:

"Starting in 2011, a family making $500,000 would have to pay $1,500 of additional income tax to help subsidize coverage for the uninsured. A family making $1 million would have to pay $9,000."

This is not a tremendous amount of money. It does have the potential to rise substantially if the government is not able to "bend the cost curve" and decrease Medicare and associated costs.

What I upsets me a bit is that we are even looking at tax raises. Don't get me wrong - I have no issues paying higher taxes - but the fact that we spend over $2 trillion and we have to raise even MORE money for health care seems ridiculous.

The issue in our health care system is about paying for health care value - not paying for more health care regardless if it has value or not. We have discussed Michael Porter's NEJM article previously on this board - but he says it best:

"What we need now is a clear national strategy that sets forth a comprehensive vision for the kind of health care system we want to achieve and a path for getting there. The central focus must be on increasing value for patients — the health outcomes achieved per dollar spent. Good outcomes that are achieved efficiently are the goal, not the false "savings" from cost shifting and restricted services. Indeed, the only way to truly contain costs in health care is to improve outcomes: in a value-based system, achieving and maintaining good health is inherently less costly than dealing with poor health.

True reform will require both moving toward universal insurance coverage and restructuring the care delivery system. These two components are profoundly interrelated, and both are essential. Achieving universal coverage is crucial not only for fairness but also to enable a high-value delivery system. When many people lack access to primary and preventive care and cross-subsidies among patients create major inefficiencies, high-value care is difficult to achieve. This is a principal reason why countries with universal insurance have lower health care spending than the United States. However, expanded access without improved value is unsustainable and sure to fail. Even countries with universal coverage are facing rapidly rising costs and serious quality problems; they, too, have a pressing need to restructure delivery."

And again, this is the issue - cost containment and driving health care value.