Monday, August 03, 2009

Political Correctness and Health Care Reform

Political correctness and the associated conceptual confusion account for much of the difficulty being experienced in achieving meaningful reform of health care.

The point is amply illustrated in an article by Victor Fuchs, a renowned Stanford University health economist, now retired, that appeared in the most recent issue of Web Exclusives by the highly respected journal Health Affairs.

In his article, Fuchs argued that reform should concentrate first on what he termed the “essentials” which he characterized as the four Cs; i.e., coverage, cost control, coordinated care, and choice.

Fuchs began by saying “First, truly universal coverage – 100 percent of Americans – is essential.”

Except for Massachusetts, every recent attempt at universal coverage has foundered on the shoals of cost, and Massachusetts is struggling. The obvious conclusion is that cost control needs to come first. Yet the political correctness of the universal coverage idea is so intense as to prevent almost everyone from saying so.

Discussion of cost control, the second C, is lengthy but, consistent with the general lack of academic interest in the subject, shows no recognition of the urgency of the problem and includes no suggestion that offers the prospect of near-term results.

Comments on coordinated care focused on indirect influences like the payment system, self-referral to physician-owned facilities, laws and regulations. Coordination is something that providers have to do. But suggesting that providers need reforming remains very politically uncorrect and there is no mention of the need for them to get themselves organized and do their jobs.

As to choice, the final C, Fuchs does gently recognize that “some restriction on choice [of provider] may be necessary in the interest of quality and cost.” However, the example he uses is not patient choice of physician but, rather, the “any willing provider” laws that compel insurance companies to pay any doctor who will accept their fees and procedures.

If we could deal with the real world rather than with the politically correct, we might:

- pursue cost control before taking up universal coverage,
- require providers to contribute to cost control by devising better and less expensive methods of care,
- require providers to take their responsibility for coordination of care seriously, and
- agree that insurance companies should have the right not to pay whatever doctor the patient picks (i.e., exercises choice) regardless of competence or efficiency.

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