Wednesday, November 18, 2009

Making our health care problems worse

Jeffrey S. Flier, the dean of the Harvard Medical School, writes today about how the Democratic health care reform ideas are the exact opposite of what our health care system needs.
Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.

Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that's not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost—and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.

In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.
So we're going to make the problems we have already worse. And, as Flier points out, the Democratic plan would once again cut off a road-not-taken, by shutting off the real innovations we need in health care reform.
Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.

In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system—now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all.
If you doubt this, look at Massachusetts and the mess that has become of their efforts to reform health care along the same model that the national Democrats now want to follow.

It would be nice if our political Solons could take the Hippocratic oath when it comes to health care reform: First, do no harm. Instead we're going to get a more expensive system that will exacerbate all that is dysfunctional with our current system and cut off needed reforms that could indeed lower health costs so that more people could afford health insurance.