I've bolded some parts for Deck. [rquoter]Health 'Reform' Gets a Failing Grade The changes proposed by Congress will require more draconian measures down the road. Just look at Massachusetts. By JEFFREY S. FLIER As the dean of Harvard Medical School I am frequently asked to comment on the health-reform debate. I'd give it a failing grade. Instead of forthrightly dealing with the fundamental problems, discussion is dominated by rival factions struggling to enact or defeat President Barack Obama's agenda. The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health—not politics—have been left in the lurch. And as controversy heads toward a conclusion in Washington, it appears that the people who favor the legislation are engaged in collective denial. 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. 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. There are important lessons to be learned from recent experience with reform in Massachusetts. Here, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but—despite initial predictions—increased total spending. A "Special Commission on the Health Care Payment System" recently declared that the Massachusetts health-care payment system must be changed over the next five years, most likely to one involving "capitated" payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change—necessitated by skyrocketing costs and a desire to improve quality—are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required. Yet it's entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire. Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law. Selling an uncertain and potentially unwelcome outcome such as this to the public would be a challenging task. It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation. So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit. We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead. Dr. Flier is dean of the Harvard Medical School.[/rquoter]
Actually a good article, but I would have bolded different parts than basso. particularly: I wouldn't be surprised to see healthcare expenses accelerate, but my primary concern is universal coverage over controlling costs. It will be a leap to get this country onto a system in which everyone has access. Once we have that, then we can do what we might to reduce the inefficiencies. Worrying about costs first and universal-access later will postpone universal-access into perpetuity and prolong a social injustice.
yeah this is where the main divide is I think. Some people just want it universal now then control costs later and some people want to get costs down then go universal. The arguments do not happen like this in the media but i think this is the main split. I think no matter what, health care will be an issue for years. This bill will not be a silver bullet. I think dems are selling it as one because they know the public option is a bell you cannot un ring and then they can control the costs with future bills.
I'm on the opposite side here. I think if you control costs, people will naturally have easier access; a big part of the reason so many people don't have health care is that it's too expensive. If you give access but don't control costs, you just bankrupt everyone over the long haul. I tend to agree with the article to some extent. I think the bill that looks more and more likely to emerge is a bad one. It mandates everyone get health insurance, but the public option is the primary cost control system. If that dies, then you're left with a requirement that people get health insurance but nothing to make it affordable - that's just a giveaway to insurance companies who just got 50 million new customers and can raise prices at will without losing them. The bills started out pretty good, but they've been bastardized in the process. You can't really partially fix health care - it's really all or nothing because everything affects everything else. The GOP and the conservative Dems seem to all have issues with small pieces here and there, but if you take out those pieces, the whole thing falls apart. I have a bad feeling that the end result bill is going to be a total disaster at this point. Everyone is simply playing politics and trying to win re-election at the cost of making a better bill. GOPers think screwing the American public and blaming Dems is the best way to go. Conservative Dems just want to be protect their own re-elections. And progressives seem so obsessed with the public option that they haven't tried to push any other options to control costs.
basso, I don't think the Dean is saying quite what you want him to say. If anything, he's asking for significantly greater reform... something that would be possible if you and your ilk weren't so adamant about supporting wealthy insurance and medical types at the expense of your own and the country's well-being. Sounds like he's part of the 10% or so of Americans who don't like the reform plans because they do not go far enough.
I thought the split was between people who wanted affordable universal coverage and the people who wanted to keep their own costs down, fellow man be damned. Maybe my prejudice is showing. I won't be surprised if the final system is a total cluster****. Congressional polarization will usually result in this outcome. Later, once it is there, hopefully everyone can agree on how to fix it. At least if it is a government function for the public good that affects everyone, everyone will be interested in getting the cost structure right.
if you want a reasonable debate, i wouldn't presume to know what "you and your ilk" want. imo, there's no reasonable argument against the concept of universal coverage. the problem has always been how do you pay for it, and as Dr. Flier points out, there's a great deal of (deliberate) obfuscation on this point. and i'd also point out that "universal" does not have to mean "government run." those of us who oppose the current bill have seen other government, or government funded, programs, from the post-office, to medicare, the Fan/Fred, to the auto bailout, to the VA, and don't view them as a model for how health care should work, universal or not.
Its nothing more freakin hilarious then when some anti government regulation person posts a criticism of government regulation because said regulation isn't regulatory enough.
Notice Obama isn't even talking about controlling the cost anymore, its now "health insurance" reform. People will support the bill as long as it doesn't take money out of their pockets, like the doctors.
I hope you're right here. My fear is that they are going to have to twist every arm and call in every favor to get this through, and the likelihood of Congress coming together again in a few years to fix it is unlikely. I'm worried that no one's going to want to touch health reform for a long time after this bill passes.
then their concerns have been met. CBO projects the senate version of the bill will reduce the federal budget deficit by $127 billion
Thank goodness. Basso will be relieved by this breaking news from the nonpartisan Congressional Budget Office. http://www.cnn.com/2009/POLITICS/11/18/health.care/index.html
it's even better The $127 billion is just the first 10 years. CBO projections over the next ten years is $650 billion.
i can't believe you're actually celebrating CBO predictions 20 years hence. my mind is clearer now. at last, all too well, i can see where we all soon will be, if, you strip away, the myth from the man...
The Republicans won this contest. The bill is so watered down and cumbersome that it is almost bound to fail. The Republicans complained and whined and the President showed NO leadership, to the point that now there is a bloated, ineffective bill that will probably only make things worse... Congrats to the Republicans I suppose.... the Democrates I say what a shame... to the President, grow a pair..... To America.... Sorry...
I find it interesting that your ilk crow about history vindicating your hero, but you are not willing to afford the same leeway to his predecessor.
If that is too much for you then focus on the 10 years hence. This is what most American businesses do every day basso. Be American. 10 years = Less Debt. Let's throw a tea party! Wait . . are you saying that the CBO is partisan? Or that the president's charisma infiltrates number crunching? Do have some more tea basso!
Rather than look at the non-partisan CBO predictions, it's better to look at one person who wrote an article advocating ideas that would require an actual government take over of health care rather than what's in the bills before congress now.
