So, I was happy to see Alain Enthoven's recent KHN op-ed.
Here is a small portion of it:
"Once again the President did not put forth serious proposals to reduce the growth rate in health expenditures in his speech last night. Obama likes to talk about the iconic systems: Mayo, Intermountain, Kaiser Permanente, and Geisinger, but the Democratic bills do practically nothing to promote their growth or systems like them."The House Tri-Committee and Senate HELP Committee bills offer none of the fundamental reforms that would be likely to change the system or significantly slow growth in expenditures. Rather, what they offer is continuation of our present traditional employer-based, non-competitive fee-for- service system. They don’t respond to the President’s call for reforms that would lower the growth trajectory, or even that would not add to the fiscal deficit."
I highly recommend your reading all of it here.
7 comments:
Dr. Enthoven makes some excellent points. However look at all the resistance the watered-down, current proposals are facing. Do you really think in our poisoned political environment there would be any chance of passing legislation that would reduce physician and hospital income by getting rid of the fee-for-service model? I don't. Insurance reform and coverage for almost everyone are good first steps. Once everyone (or almost everyone) is in the pool, then we can start to reform the payment system.
Aside from the flap about the Public Option, the main oppositon to this bill involves cost considerations. Only by reducing the cost of care can we hope to pay for the insurance reforms included in the bill. Medicaid expansion and subsidies for low income workers are critical to the success of any reform plan but they cannot be paid for with vaugue promises about reductions in Medicare spending. Only system wide reform, including an overhaul of the fee for service model will result in the savings we need. The President and Congress are playing to the crowd by appearing to give them what they need while quietly cutting deals that will only lead us to unaffordable health insurance for all.
Enthoven's analysis is, of course, brilliant. But his prescriptions remain the same and impractical...just as they were in his Health Affairs articles in 1993.
I keep getting the sense that he's right and society is wrong...which is never a good basis for public policy.
I would like to see his thinking evolve - just as our political / healthcare systems have evolved - and recommend something new. Now that could be a contribution worthy of his talent.
GF
GF:
He did support a new idea.
Wyden-Bennett.
It is ironic that some, labor unions for example, demand bold and risky health care policy--by anyone's estimation--but think W-B is too much change because of the impact it could have on the traditional benefits market.
Bold is OK so long as it doesn't gore your ox!
While I personally see the value in Wyden-Bennett the system is resisting it as being too radical a change at this time. Like it or not, we've created a culture of dependency. Individuals who are not dependent on the government for coverage depend on their employers. Not so long ago, guaranteed issue and individual mandates were almost considered Communist plots, but the system came around. It will come around to portable individual coverage but not this year.
Only about 5% of Americans actually buy their own coverage and most of those by necessity not by choice. For all its logical restructuring of the financing mechanism and the tax system, W-B still has a tough road to travel before it gains political acceptance. When surveyed, individuals still overwhelmingly prefer coverage that (they think)is paid for by someone else. Dah...
But doesn't at least the House bill put in place, via the Public health plan option and reform to Medicare (I think), mechanisms to start to lower costs through CER? And don't the investments in primary and wellness care also start to build cost-lowering structures? Isn't cost lowering about putting these structures in place now rather than demanding them to happen immediately, which would be practically impossible?
Yes it is not health-care reform. It is a new health insurance bill. It will not reduce costs or improve overall health.
Here is an alternative to the government's plant:
http://hoothoothoot.wordpress.com/2009/09/15/health-care-reform/
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