A good friend sent me a recent op-ed from the Washington Post that discussed the 5 myths of health care reform by Shannon Brownlee and Ezekiel Emanuel.
I’ve written about both of them before (here & here). Brownlee is a visiting scholar at the NIH’s Clinical
Center, and Emanuel is the chair of the Center’s Bioethics Department.
Ezekiel also happens to be the brother of incoming White House Chief of Staff Rahm
Anyway, I really like most of what they have to say – which will
probably come as a surprise to them – and maybe to some of my
colleagues as well. Their five myths are, in no particular order…
1) America has the best health care in the world.
2) Somebody else is paying for your health insurance.
3) We would save a lot if we could cut the administrative waste of private insurance.
4) Health care reform is going to cost a bundle.
5) Americans aren’t ready for an overhaul of the health care system.
On No. 1 – Let’s face it, this one’s been beaten down
for years in study after study after study. We certainly spend the
most, but I’d be really hard pressed to find any study that indicates
that spending the most money translates into high performance. I don’t
think we’re as bad as some would suggest because we’re playing a much
more complicated hand demographically than most countries. And frankly,
many of the health status measures people rely on have a lot more to do
with diet, exercise, and public health than the quality of the health
care delivery system.
They’re dead right on No. 2 as well. Private health insurance premiums
are part of total compensation. If the cost of health insurance is
going up, it’s usually being paid for by incremental reductions in wage
increases. In addition, we all pay for Medicare, Medicaid, public
health care, Veterans Health Care and other forms of publicly funded
health care every time we pay our taxes. Employers and governments
don’t “fund” health care. People do.
I’m obviously an “interested party” on #3 – and I’ve posted commentary on this issue before (10/6/08).
Believe me, if I thought just whacking the private plans into oblivion
would solve the cost problem, I’d be hard-pressed to oppose it. But I
know the math is mostly about the cost of care, and it’s nice to hear
someone else say it.
No. 4 is a bit more tricky, but not because I disagree with their
fundamental assumption. I just think saying you can reform the
delivery system enough to save the money you need to save as you go
about the process of enrolling the uninsured is the all-time, Hall of
Fame, Numero Uno “easy to say, but hard to do” concept. The system is
expensive and inefficient, but in many ways, its design is due to
the interests, expectations and objectives of the people who
participate in it. In other words, it didn’t get this way by accident; it just looks like it did.
No. 5 is also kind of tricky. People say, generally speaking, that the
system needs an overhaul – right up until that overhaul affects the way
they use the system now. The challenge for the feds is translating
that over-arching sense that something has to happen, which is shared
by most voters, into specific plans and policies that reflect the
change most people are anticipating. This is also easy to say, but
very hard to do.
But that said, this is a good list. I look forward to more as this whole discussion rolls forward.
#3, No “whacking the private plans” won’t “solve” the cost problem but it would create a system that could solve the cost problem through enforced universal budgets. It would also relieve docs of negotiating with multiple insurers and the billing paperwork that creates. It would also guarantee everyone gets paid.
#4, Cost a bundle to whom? The patient? No it will (potentially) cost a bundle to all the suppliers that have created this mess. But like the real estate agents, appraisers, mortgage brokers, bankers, and investment creators/dealers that created the finacial mess, the government will not let participants in the healthcare industry fail from their own sins. Yes, it will (once again) probably cost the taxpayer a bundle because no action was taken early on. But if we can justify “social solidarity” to Wall Street (and Detroit), we should be able to justify it for healthcare.