Tuesday, February 17, 2009

A New Approach to Health Care Reform

An April 27 posting to the American Hospital Association’s blog hospitalconnect.com reported on a speech by Nancy-Ann DeParle, the newly appointed director of the White House Office of Health Reform. In the speech, Ms. DeParle described eight simple principles that will guide the administration’s health reform efforts. I list them below together with my comments.

1. Any plan must address ways to control long-term growth in health care costs. “Reform that does not control costs is no reform at all.”

Comment: Right. I think it noteworthy that this principle appears first.

2. Families must be protected against bankruptcy or crushing debt from health care costs.

Comment: Agreed. This principle might be interpreted to imply universal health insurance coverage. It could have said that, but it doesn’t.

3. Americans must be allowed to choose their own doctors, hospitals and health plans. “The Obama administration will not force patients to change providers or plans.”

Comment: Perhaps a politically necessary statement but, as I have pointed out in previous postings, it is not consistent with the cost control called for by principle 1. Note, however, the careful parsing. It doesn’t say that patients won’t be forced to change. What it says is that the Obama administration won’t do it.

4. The nation must make a real investment in prevention and wellness.

Comment: A platitude with unclear implications. Does “the nation” mean the federal government?

5. Any reform measures must take significant steps to ensure safety and improve quality of care.

Comment: Another platitude. One wonders what kinds of “steps” are being considered and why they have to wait for “reform.”

6. The nation must ensure affordable, quality health care for all Americans.

Comment: A clear gesture towards those plumping for universal coverage but I note that, again, it puts the responsibility on “the nation,” not the government.

7. Health care coverage must be maintained for Americans even when they lose or change jobs.

Comment: An appealing thought, but as a practical matter, what can be done beyond COBRA, the current program that lets employees who leave their jobs keep their health insurance for a period at their own expense?

8. Insurers must end barriers to coverage for people with pre-existing medical conditions. “This is rationing health care, plain and simple, and it will not be tolerated.”

Comment: Another appealing thought, but if anyone knew how to do it, it would probably have been done already. The remark about rationing is gratuitous. Health care has always been rationed and always will be. The question is who should do it?

My final comment is this: Although these principles are carefully designed to touch the political bases, they comprise a new and potentially potent approach to health care reform. Up to now, the focus has been on “universal coverage” and “the uninsured,” words that do not appear in this list of principles. As I have pointed out previously, it would be good if everyone had health insurance, but we can’t afford it until and unless we get cost under control.

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