Matthew Holt

“The possible” vs “what we want,” resumed

Not so long ago (actually less than 2 weeks), there was quite the spat on THCB between the Four Horseman (Klepper, Kibbe, Lazewski & Enthoven) and Maggie Mahar. Essentially it came down to this question:

Is there enough in the current House & Senate bills to restrain spending and remake the health care system? Or is the whole effort so bought off by the health industry as to be a waste of time?

I put myself in the camp of agreeing with both the Four Horsemen (that the bills were pretty much emasculated) and with Maggie (in that at least we’ll get some significant improvements in coverage for the uninsured).

And don’t they need it. In fact I wonder how many of the 50–odd million uninsured and the 50–odd million Americans who don’t have enough to eat are the same people.

But today the chorus of “fiscal responsibility through health reform” being orchestrated by the Administration got a little louder. It started about a week ago with Peter Orzsag banging the drum for health care reform being deficit neutral. He pointed to a letter from a group of moderate to liberal economists supporting HR 3962.

Today many of that same group (although not all and without the non-economists) were joined by some heavy hitters on the health economics side supporting many of the tenets of the Senate bill. This new group includes many of the same liberals but also some sensible Republicans (well Mark McClellan) and some real big guns including Uwe Reinhardt, Victor Fuchs, Joe Newhouse,  Laura Tyson, Henry Aaron, Alan Garber and Kenneth Arrow. Alain Enthoven (one of the Four Horsemen) is notable by his absence.

However, the economists probably wouldn’t disagree with the Four Horsemen about how limited the changes in the Senate and House bills actually are, and they appeal for an independent Medicare Commission and serious delivery system reform—all of which will be emasculated in Congress. But nonetheless they are providing valuable intellectual cover for the Administration—no one on the other side will be able to put a crew like this together! Meanwhile over on the Health Affairs blog Jack Wennberg (with Shannon Brownlee) is giving an assist by stepping up his counter-attack against the Academic Medical Centers who are complaining that their patients are sicker.

So the “realists” are coming out in support—all believing that once we get the legislation out of Congress and into sensible hands within the Administration there’s a chance that we might be able to do some good in terms of delivery system change.

Stay tuned. This is a good reason to keep reading THCB for the next decade.



Categories: Matthew Holt

2 replies »

  1. I don’t understand the focus on “getting everybody covered” and it seems to me it’s taken for granted that “getting everybody covered” is going to cover any and all medical procedure or technology they might ever need or want. Am I misunderstanding the debate?
    We should be focusing on why it’s so expensive in the first place. “getting everybody covered” is like giving everybody a car with no engine or transmission. Abortions, that’s a one-time procedure that cost, what, at best a few hundred bucks at worst maybe up to $1000? You want an abortion? Go get one. Why is this such a topic of debate? I could understand the conversation if we had a smallpox outbreak and people couldn’t afford immunizations, that’s a public health threat. Whether insurance or Uncle Sam covers abortions is not a public health threat. Maybe the public option should cover “rescue” care? Maybe people should be able to purchase private insurance for whatever that policy wants to charge for whatever they’re offering to cover? We do need regulation of the insurance industry, we definately need regulation of the health care industry, but simply “getting everybody covered” is N O T going to drive down health care costs. I have a real problem being ordered to purchase a defective product (insurance) and being ordered to finance a defective industry (health care). I think everybody should watch this webcast Consumer’s Union broadcast yesterday. There are a lot of facts from experts in their field regarding the health care industry. No one of us on these blogs has all the answers and I think you owe it to yourself to invest the time to listen to what these people are telling us:

  2. So, Matthew,
    You are posturing to claim victory no matter what piece of legislative garbage comes out under the banner of healthcare reform. Go for it.
    Until the patient gets to the exam room, their is no healthcare in the first place. read that as delays, detours, red tape, and shortage.