Dr. Atul Gawande is one of the leading thinkers on health care (and an Ohioan!). Earlier this year he wrote a fantastic article which explored some of the heart of cost issues in health care. Built around the Dartmouth research into comparative effectiveness and examining some of the perverse incentives in the system, he writes clearly and convincingly about what reform could look like. Now with a health care bill that he can dig into, he writes a must read article exploring what the saving grace of the current bill might be and why health care reform in general is so tricky. If you can’t get through the whole article here’s the few sentence overview:
To get health care reform that actually matters, “cost” is the ballgame. How we actually get lower costs is not simple however. Given how varied and diverse (location, specialty, insurance type, etc) our current system is, it is exceedingly difficult to come up with a silver bullet solution. Therefore, we need to do what has worked for us in the past (example: US agriculture policy)– testing. Half of the current bill are provisions for test programs that could (hopefully) some day soon be the fundamental reforms we need to save our national solvency (by getting long term health care costs under control). Read the article.
I’ve said in press interviews and in individual conversations with voters that this health care bill leaves a lot to be desired. It looks badly compromised by appeasements to special interests (big pharma, insurance companies, etc) and most recently by giveaways to specific legislators seemingly in a quid pro quo for their vote. Dylan Ratigan recently took a Rep to task for the giveaways to insurance companies that fail to control costs by increasing competition. His method aside, I completely agree with Ratigan’s point: the current bill fails to provide true choice to consumers. Choice is the only thing that can decrease costs and reform on the insurance side by forcing the companies to compete– something they don’t really do today. The Wyden plan offers this but, like most fundamental reform, never got off the ground, sadly ignored by both sides. A good summary of where we stand today, and a good balance to the optimism from the earlier mentioned Gawande article, is this Bill Moyers video with Taibbi and Kuttner.
While the bill keeps evolving (best I can tell it’s now up to 2000 pages), the hope is that in the end it will be, on balance, positive. Without health care reform we guarantee national bankruptcy. That’s pretty much a consensus opinion. The saving grace for this bill could come from: 1) the test pilots that lead to fundamental changes down the road, and 2) gradual revisions to the system that will get at cost savings from pharma, insurance, tort reform, etc that couldn’t be included in this bill due to special interest control.
Reading list mentioned in the article:
- Bill Moyers interview with Matt Taibbi (journalist) and Robert Kuttner (economist) [video]
Comments on this entry are closed.