From my perspective the attention is 30 years late; thirty additional years of a cancerous tumor I diagnosed in 1980. It's taken many decades of runaway price increases; trillions of wasted dollars going to an industry blessed with the storybook goose that lays the golden egg. And over in this corner we have the Democrats (Dems) with notions of regulating insurers and a public insurance option as the cure, and in the other corner we have the Republicans (Pubs) prescribing a regimen of shifting the purchase of health insurance to the consumer and putting further limits on medical liability claims.
Little do the liberals and progressives realize that the 'Teabaggers', those staunch and loud opponents of health care reform, have provided the country a service. While their fears are misguided, they have halted implementing an insufficient fix, though any fix might be better than the status quo. But a poor fix, could delay by many years, or decades, rooting out the actual problem. On the flip side, the Pubs' plans are a mixed bag, also better left stifled. With any luck, both the delay from this stalemate and the intense pressure to do something will drive more thought by those who have the power to make changes.
Right now, I would say that the medicine ball is in the Pubs' court. The New York Times asked five conservative 'thinkers' to speak out with their best ideas for slowing the growth of health care expenditures and expanding the number of insured Americans. I'll try to sum up their pitches, and then will grade each on problem solving.
Newt Gingrich, the former Speaker of the House of Representatives and founder of a for-profit consultation group, dubbed the Center for Health Transformation, which appears to be a front for undisclosed lobbying services, responded that 'frivolous' malpractice lawsuits against health care providers (the gift of a political 'red herring' for conservatives that just keeps on giving) is what ails us and that by us limiting the accountability of health care providers we can bring about affordable health care.
James Pinkerton, former domestic policy aide for Reagan and Bush I, and fellow at the New America Foundation, a policy think tank, summed up his thoughts with, "A 'more health' plan is a win for individual health, a win for economic growth and, yes, a win for the cause of long-term health savings." Looking past his beauty pageant response, I've tried to cull out his proposal and inferred that he wants to spend more on medical research and in so doing it will, both, give Americans what they really want, which he says is more or better health care, and will be the economic engine of our new economy.
Mark McClellan, former Medicare administrator under Bush I, and director of the Engelberg Center for Health Care Reform at the Brookings Institution, references a few commonly raised solutions, but uses most of his ink on the notion of performance based compensation, though he couches it with a more Republican friendly 'cost savings' measure of performance. He acknowledges that Dems are out front on the 'performance' concept and challenges Republicans to get on board by seeing that Medicare is capable of measuring patient outcomes.
Charles Kolb, former domestic policy adviser to Bush I, and president of the non-partisan Committee for Economic Development, promotes weaning Americans off of their employer provided health insurance to create a far more competitive market in health insurance, and placing some type of risk adjustment compensation mechanism in the mix to incentivize coverage among all health risk categories. He adds that ending the current tax exemption of payments for employer sponsored insurance would help to publicly provide insurance for those currently uninsured.
Bill Frist, former Senator from Tennessee, and a surgeon, also endorses some frequently mentioned measures, but offers that they will never provide the fundamental change the system needs. He adamantly promotes packaged based compensation, by insurers, instead of fee for service, which he cites promotes volume over both quality and efficiency. Packaging would entail all the services, personnel and pharmaceuticals needed to treat a particular health care 'event'. He, also, harshly criticizes leading Democrats for lacking any faith in market economies or "in the power of hundreds of millions of people to make smart choices about their health."
Half of the Times inquiry, how to expand the number of insured Americans, was virtually untouched by the writers, but perhaps space didn't allow for addressing both subjects. On the positive side, it seems that a good portion of the Republican establishment is now admitting there is a problem beyond simply blaming trial attorneys. In fact, I was surprised to see one of the responses go so far as to suggest results based compensation, a pretty revolutionary idea for health care here in America, and another propose a change in the structure of health care pricing away from itemized treatment to packaged case management for health care events, also a sea change in our system.
I am surprised, because those notions go beyond simply urging the control of prices by positioning consumers to make cost/benefit value judgments in their choice of health care services. They are suggesting that an entity other than the patient make a judgment on the quality and efficiency of care; that is the stuff of warning signs at 'Teabagger' rallies showing why we should fear government run health care. Perhaps, some of these conservative 'thinkers' don't reflect the intellect of their base.
I've given grades, in order: F, F, B-, C, B-
Gingrich is so lacking in depth as to be almost pathetic. He is a front for the insurance industry, still pushing his tort 'reform' agenda to allot more profits for insurers and health care providers who want to, with damage caps, budget in their maximum liability for negligence. His home state of Georgia implemented such legislation in 2005, and I've not yet been apprised that health care in Georgia has become more affordable or available in the interim; but logically more risky for the patients.
James Pinkerton appears to have had little exposure to the price of health care today. His call for improving research is admirable, but not a subject of any controversy or pertinent to the problem at hand. Kudos for thinking broadly, in recognizing the economic impact of 'medical industries', but his notion that spending more money to get healthier and therefore be more productive is hardly worth comment. Yet, with America losing so many of its economic sectors to international competitors, medical research and innovation is an industry worthy of investment; but don't confuse it with the practice of health care.
McClellan goes for the efficiency method of reducing costs, suggesting that providers should be compensated based on how much their care reduces long term costs. It is closely aligned with results based systems, a positive sign, as long as the health of the patient is one of those results. He suggests that providers show "the way they prevent and manage illnesses reduces complications and cost Medicare less." As a former Medicare administrator, he believes Medicare is capable of creating a means to measure such results and appropriately apply them, given the resources. I'm going to take a leap here, by likening his proposal to that of the British health care system, though perhaps he intends it only for current Medicare recipients.
Though, given a grade of C, Kolb did a good job of identifying much of the problem, but failed to go beyond the marketing of insurance in his analysis. He chastises liberals for unrealistic idealism and conservatives for hypocrisy, and correctly recognizes our market-inadequate health care system he calls "a pre-World War II dinosaur awaiting extinction." He is the only one who specified a means to help cover those currently uninsured, though it lacked any punch. He should take his market oriented thinking to the next level, the point of health care consumption, beyond insurance consumption.
Bill Frist, certainly, doesn't lack passion for the subject. He astutely recognizes a need to utilize the power of value judgments in markets, but doesn't really followup on that idea. His central solution, which is to price health care by packaging related treatments instead of the current piece meal method, has the right goal but isn't alone likely to stem the rise of or reduce prices in health care. Yet, in his argument, I see he places an emphasis on value; that along with his perception of market functions indicates he believes we need to achieve a point at which consumers are using value judgments to make cost/benefit comparisons, and from there both quality and efficiency will ensue, the only means to moderate prices.
While their responses give me some hope that wisdom will prevail, I recognize that Congress is not a think tank. We don't elect our best and brightest to run a large part of our lives, yet we insist on it in the operating room. Odd, isn't it?
-RLee
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