There’s an op-ed in the New York Times from five conservatives with constructive ideas on how to improve health care reform: Bill Frist, Mark McClellan, James Pinkerton, Charles Kolb and Newt Ginrich. Well, at least four of them have sound ideas.
I think that former senator Bill Frist’s snarky intro that the Democrats have “failed at healthcare reform” is not only premature (and immature), but to say that “they don’t believe in markets” is something people outside the US would just laugh at – given that the Democrats are arguably to the right of some of the rest of the first world’s conservative parties.
However, I do think he’s really onto something fundamentally essential to healthcare reform when he argues that:
The most powerful way to reduce costs (and make room to expand coverage) is to shift away from “volume-based” reimbursement (the more you do, the more money you make) to “value-based” reimbursement… The only way to [strengthen the healthcare system] is to align the incentives of doctors, hospitals, pharmaceutical makers and other health care providers through value-based purchasing.
The current system values ‘throughputs’ over ‘outputs’ for several reasons, and turning this equation around would make a huge difference to both the quality and cost of the care Americans receive.
Former Bush Medicare administrator Mark McClellan also talks sense when he sees the need for “meaningful changes in medical liability law; better opportunities for people to save money when they take steps to lower their health care costs; and Medicare savings from greater use of competitive bidding.” I guess they weren’t allocated the space to expound further, because I’d love to hear what shape meaningful changes in medical liability law would take. (That’s one of the biggest elephants in the room – America’s absurd medical litigation laws. Good luck trying to take on the American lawyers association in reforming that).
But McClellan nails it when he points out that:
Currently, doctors lose money when they work with nurse practitioners, pharmacists or wellness programs to help patients avoid costly complications — because Medicare doesn’t pay for this, and it results in fewer billings for the visits, tests and procedures Medicare does pay for.
Like I said – throughputs over outputs.
James Pinkerton, well, I tried to find something other than platitudes in his argument that spending more, so better technology will make everything better, but failed.
James Kolb, a former domestic policy advisor for H. W. Bush reiterates the point that “Medicare is an inherently inflationary fee-for-service system that rewards volume, not value”, but then proceeds to admit that “Market-based strategies cannot cover the uninsured or prevent some insurance companies from covering only healthy Americans.” Fairly sacrilegious stuff for a Republican, and all the more salient for it.
I think he gets at a major flaw in the Democrats’ attempt to reform healthcare legislation. Because the Democrats are shit-scared of repeating the mistakes of the Clinton era, they’re timidly attempting to build on an anachronistic system that massively expands the bureaucracy required to run it, when precisely the opposite approach is needed.
Our existing employer-sponsored system — a pre-World War II dinosaur awaiting extinction — offers most Americans little, if any, real choice among competing insurance plans. Both parties should jettison it in favor of giving Americans better health care choices.
That employer-sponsored system was relevant when a majority of Americans were employed with the same company for life. In today’s world, Gen X’ers and Y’ers are lucky if they’re at the same job for more than two years. It needs to go.
Former speaker of the House Newt Gingrich argues that expensive procedures such as CAT scans, blood tests, ultrasounds and Caesarean sections are often ordered unnecessarily because of the perverse incentives of the current system, with the result that:
A new Gallup poll, commissioned by Jackson Healthcare, indicates that doctors believe an astounding one in four health care dollars is now spent on unnecessary care… Doctors order these procedures to protect against frivolous suits filed by trial lawyers seeking an easy payout, particularly after a doctor makes a simple mistake. Seventy-three percent of the doctors surveyed said they had practiced defensive medicine in the past year. As a result, American patients not only endure extra hours of tests and treatments but also pay more for health care.
So respect to Newt for pointing out the elephant in the room – the first Republican to do so that I’ve seen. It’s certainly hard to disagree with his declaration that:
Congress must give states the incentive to reform their civil justice systems so that lawyers will think twice before suing doctors for frivolous cases. There is a place for health courts that address only medical malpractice cases, and a need for caps on damages for “pain and suffering” that have nothing to do with lost wages or actual damages.
What I think Americans would love to see out of the forthcoming bi-partisan healthcare summit is exactly how Republicans would realize the ideas published here, because they’re good ones.