Monday, February 26, 2007
The Need for a Better Answer
Those who are interested in Medicare for All or other form of government sponsored universal health insurance should pay attention to the federal budget recently submitted by President George W. Bush.
The administration is understandably concerned about the spiraling cost of its health care programs. There are two possible ways to deal with that. One would be to take steps designed to reduce the cost of providing care. The other is just to pay providers less and leave them to do the best they can.
One way to approach reducing cost is to cause providers to become more efficient by changing the way they provide care. In any change, there are winners and losers. The losers complain. Politicians thrive on appealing to the disaffected and quickly promise to stop or reverse the change that is causing discontent. Perhaps the best current example is the eagerness with which politicos advocate “getting medical decisions back in the hands of doctors and patients.”
Another approach is to support programs that seem to promise improved efficiency without difficult changes. One example is the promotion of the electronic health record. Another is Medicare Advantage, a program that attempts to entice patients into supposedly more efficient managed care plans (i.e., HMOs).
These proposals allow politicians to be seen as “doing something.” Actually, they make reaching a solution more difficult. Medical decisions are at the core of health care and restricting them to doctors and patients ties the hands of whoever undertakes to make the system better and more efficient. The electronic medical record and Medicare Advantage are promoted by means of government subsidies, thereby infusing new money into the system without requiring the fundamental changes in how care is provided that would make them effective. The result is to raise cost even further.
While these approaches provide short term political benefit, they do not relieve the financial burden and when things get too tight, the problem is quietly passed along to providers by simply paying them less, which is what the recently submitted federal budget calls for.
So the natural result of universal government-sponsored health insurance is a health care system that is overcommitted and underfunded while being resistant to the changes needed to reduce cost.
We need a better answer than that.
Those who are interested in Medicare for All or other form of government sponsored universal health insurance should pay attention to the federal budget recently submitted by President George W. Bush.
The administration is understandably concerned about the spiraling cost of its health care programs. There are two possible ways to deal with that. One would be to take steps designed to reduce the cost of providing care. The other is just to pay providers less and leave them to do the best they can.
One way to approach reducing cost is to cause providers to become more efficient by changing the way they provide care. In any change, there are winners and losers. The losers complain. Politicians thrive on appealing to the disaffected and quickly promise to stop or reverse the change that is causing discontent. Perhaps the best current example is the eagerness with which politicos advocate “getting medical decisions back in the hands of doctors and patients.”
Another approach is to support programs that seem to promise improved efficiency without difficult changes. One example is the promotion of the electronic health record. Another is Medicare Advantage, a program that attempts to entice patients into supposedly more efficient managed care plans (i.e., HMOs).
These proposals allow politicians to be seen as “doing something.” Actually, they make reaching a solution more difficult. Medical decisions are at the core of health care and restricting them to doctors and patients ties the hands of whoever undertakes to make the system better and more efficient. The electronic medical record and Medicare Advantage are promoted by means of government subsidies, thereby infusing new money into the system without requiring the fundamental changes in how care is provided that would make them effective. The result is to raise cost even further.
While these approaches provide short term political benefit, they do not relieve the financial burden and when things get too tight, the problem is quietly passed along to providers by simply paying them less, which is what the recently submitted federal budget calls for.
So the natural result of universal government-sponsored health insurance is a health care system that is overcommitted and underfunded while being resistant to the changes needed to reduce cost.
We need a better answer than that.
