Bob Laszewski’s Health Care Affordability Model has the same connection to the reality of the current battle over health care reform as a Fantasy Baseball League does to the actual outcome of a major league baseball game; i.e., none.
Actually, while those who play Fantasy Baseball – might we call them “baseball wonks”? – are affected by what happens in the real world to the players they have selected, they have no illusions of reciprocity. Laszewski is a brilliant analyst whose examination of the various political proposals for health-care reform have become a “must-read.” But in making his own proposal, Laszewski, a strategy consultant based in Washington, has managed to completely ignore the fact that reform is an intensely political process.
“The Health Care Affordability Model…could be attached to virtually any health care reform plan now on the table,” he writes.
No, it couldn’t. Just like managing a Fantasy Baseball team has no connection to managing real major league players. Given Laszewski’s timing, his proposal is somewhere between almost irrelevant and completely so. Which is not to say his ideas are wrong.
There is a long tradition of Deus ex machina books on health care, which I’ll translate as “If I were God, here’s how I would fix the machine.” Three of the more prominent recent contributions, all of which I think have a great deal of merit, are Harold Luft’s Total Cure; Ezekiel Emanuel’s Healthcare, Guaranteed; and Critical: What We Can Do About the Health-Care Crisis,” written by former Sen. Tom Daschle and two even wonkier co-authors.
To these I would add the Deus proposals (“I’m God, don’t bother me with the details”) that we get from single-payer and health savings accounts evangelists, and plain old Machina (“Forget God, give me lots of details!), embodied by the Prometheus payment model propagated by some of the hard-core wonks among us.
These, however, all emerged before the political dogfight over reform reached its current intensity. Laszewski’s complicated proposal ignores political reality, as if his proposal to penalize health plans who spend too much money should be gratefully accepted as a basis for legislation by elected representatives who just saw comparative effectiveness research that didn’t even include the word cost manage to inspire virulent opposition comparing it to Nazi euthanasia. In other words, it’s a proposal designed to repel Republicans and terrify Democrats.
I hedge on this proposal’s irrelevance because I believe final health reform legislation will take the shape of the classic “Christmas Tree” bill, with various baubles added on in the dead of night. Laszewski is a smart man with good ideas, and one or two of them may get plucked into place. Alternatively, after legislation passes, his proposal – and those of many other wonks whose work I like and respect — may provide some ideas to regulators who I think will have plenty of wiggle-room on specifics.
Meanwhile, I’ll continue to believe that if I wear just the right lucky t-shirt the Cubs will win the World Series.