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Fantasy League Baseball — Beltway Series Edition

Millenson_122k_3Bob 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.

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12 replies »

  1. Notwithstanding Deron’s colorful language, I agree with his point about government not being the driver of most truly innovative directions. They’re useful for supporting basic research, but not so great at converting these to a better health care system.
    What will ultimately drive this is demand. Motivation for the private sector to drive health care in this direction will be directly proportional to how large a business opportunity they (and their investors) see in getting there first.

  2. So are all of you saying that you’re ok injecting a trillion bucks into an already expensive system? This really saddens me because we’ve pretty much all become numb to the fact that it’s the same ballgame no matter which industry: the private sector screws up, government steps in, and the underlying problems that caused the mess in the first place never get addressed. I don’t think it would be a stretch to say that this isn’t what the Founding Fathers had in mind for our country. Does this practice officially end when the Chinese assume complete control over our country, or are we going to get it right before then?
    Put a frickin’ group of smart people (read: not congressman) in a room, task them with identifying the cost drivers and quality issues within the system, allow them to propose solutions, THEN use the power of Uncle Sam to make it so. What am I missing here?
    The collective intelligence of the THCB regulars is mind-boggling, yet everyone seems ok with handing the keys over to our elected officials (Michael used some form of the word politics 7 times in his last response). Sure, the private sector is greedy as hell, but it is light years ahead of government in terms of intelligence. It would be counterintuitive to not figure out a way to harness than intelligence, while minimizing the greed. It might sound like a pipe dream, but ask yourself what good has come from the U.S. government in the last 30 years.

  3. To be clear:
    I do believe, as Bob says, that we are in the final moves of the chess game for now. “For now” meaning that modest success will bring us the chance to do more, while abject failure may bring us another decade or two hiatus.
    Me? I’m perfectly willing to let Laszewski, Luft, Emanuel and maybe even Daschle (even if he is a politician) go into a room and come out with the perfect health system reform plan. But that’s a pipe dream.
    I believe in dreams, but if you want to make them a reality through hard work, as a commenter recommends, then you’ve got to roll up your sleeves and get involved with politics. That approach, after all, is what Paul Ellwood did to get his HMO dream passed into law. And that involvement with politics is what made managed competition a mainstream idea for health reform (even if its authors didn’t like what politicians eventually did to the concept).
    Any proposal for reform made at this moment in history by a respected player like Bob should meet a political reality test. Bob asserts that his proposal can help Congress (the real world) in health care reform right now (the real world), but never addresses any political realities.
    I applaud his aspirations, but it’s fantasy baseball. His approach won’t do anything to help our common goals come to fruition in the real world of political hardball.
    And I’m not too hopeful about the Cubs this year, either

  4. Anyone who can relate both Second City comedy and the Cubs’ World Series title prospects to health care reform efforts knows what they’re talking about 🙂
    Michael’s observations about political hardball driving what will ultimately get passed as health care reform by Congress are on target, and are why true reform is so elusive. Cost containment is not the type of approach which will marshall support, but rather a great way to get legislation killed by well funded members of Congress.
    The only way that the tax deductibility of health benefit plans will be altered is if there is no other way to pass any legislation without doing so.
    It’s much more likely that, as in Massachusetts, the “low hanging fruit” of expanded access is modestly supported.
    And the Cubs aren’t likely to win the World Series this season, either…

  5. Given how much time Congress recesses for the rest of the year, other large issues on the table, and the looming reality that there will be no growth/recovery this year, the HC reform endgame is coming much sooner than people realize.
    In fact, I would be willing to bet good money that if there isn’t a substantial bill that Congress would stay beyond Oct. 30 for and not adjourn for the year, the chances of seeing a big HC reform bill from this president will approach 0%.

  6. I am not necessarily in support of all that he suggests, but it is silly to trash an idea.
    Everything is a fantasy…that is where we start. It is how we take these fantasies and make them good for masses.
    What you are suggesting is that everyone shall live by your insecuritiies….and yes a professional version of that is understanding of reality.
    I have my own model, which somehow the publisher here decided not to share with the readers. Probably they did not feel it was part of their league or it was even bigger fantacy. A version of that I put it on my blog.
    Anyway….why not we create an utopian goal and then work towards achieving those. People say if you shoot for the star, you might still land….
    Few years back, a black kid would have been told that wanting to become a president is a fantasy…heck Obama did not even get pass for convention I think in 2000.
    It is the dream and then hardwork. Without dream we got nothing.
    rgds
    ravi
    blogs.biproinc.com/healthcare
    http://www.biproinc.com

  7. “Michael, please don’t take this the wrong way, but I think this should have been posted as a response comment to Robert’s post, so we can all have one good conversation on this issue, instead of fragmenting it into two separate ones. Other than that, lovely post.”
    I believe we need a lot more than that.

  8. Michael:
    I think there are a few complements in here!
    Reform is an intensely political process. And, it’s a chess game.
    You seem to think we are in the final moves.

  9. Michael, please don’t take this the wrong way, but I think this should have been posted as a response comment to Robert’s post, so we can all have one good conversation on this issue, instead of fragmenting it into two separate ones. Other than that, lovely post.
    P.S. My son has been trying that lucky t-shirt theory with the Cubbies for 5 years now…. the results are on the public record….

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