The health reform debate has taken an odd turn. At a time when all the parties with a direct interest - hospitals, doctors, insurers, drug companies - are working toward a political compromise, daunting new roadblocks are created daily by those with a broader political agenda who won't be directly impacted by the outcome.
Each time politicians seeking to make a deal try to move the ball forward - whether it is President Obama making deals with the drug companies or hospitals or Finance Chair Baucus trying to corral votes by constraining costs - there's a vocal reaction from those who can't tell the difference between making a deal and selling out.
As Sheri and Allan Rivlin point out in their latest analysis, there's a continuing danger that the effort will be derailed by Democrats on the left who demand a clear victory over the Republicans by enacting a public plan and Republicans on the right who return the favor when say that trying to limit care to what is needed rather than wanted is an intolerable assault on American freedom.
The issues are complicated and perfection may once again be beyond the reach of our political system (however often each of us achieves it personally), but making things somewhat better isn't rocket science. Expanding coverage by ending the bias against pre-existing conditions is a positive step. Squeezing out tests and procedures that yield few positive results is a no brainer.
Goo Goos (the affectionate nickname for the good government types who worry about the powerful having undue political influence) suggest giving a larger role to allegedly value-free bureaucratic mandarins who'd decide what type of care is appropriate. They'd lock all parties with financial interests out of the room and allow their sleek machine to do its job - deciding who'd get paid for doing what - shielded from the corrupting messiness of the political process.
Their idea is an interesting one. But there's at least a chance they have things totally backward.
Perhaps it would make a sense to lock all the parties at interest in a room - basically the providers and those who pay - and let them make a deal, excluding the bloggers, cable TV talkers, op-ed authors, advocacy groups and fund-raisers, all of whom seem to have more interest in heat than light and none of who can deal with the possibility of a solution that will deny them an issue that has served them so well for so long.
Others have suggested that health won't be reformed until everyone involved has some skin in the game (an argument against shielding patients from real costs with insurance payments). That environment is nowhere in sight. But the idea of limiting the debate to those with skin in the game seems promising.
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You can't tell the players without a scorecard in the old Washington shell game. Lobbyist out, lobbyist in. They've been plowing this ground for years, and the soil has never been so fertile.
Patients are the ones with skin in the game; hospitals, doctors, clinics, politicians, etc. are all jockeying to CONTROL (ie, monopolize, restrict, whatever) the healthcare product with laws and mandates and protected monopolies (medicare, state selected insurers, mandates on what insurance policies can cover).
And setting up yet another "controlling" monopoly ("public option") just adds to the problem.
Until the "controllers" focus on efficient health care delivery, instead of health care control, the patient loses.
No different with the public education monopoly setting up so-called "charter" schools, and totally ignoring vouchers. Let the parents decide.
Nevertheless effective health care delivery is patient centered, patient empowered with access to a) detailed history, ratings and patient comments on physicians, hospitals, clinics & suppliers; b) patient access to their medical records; c) patient access to diagnosis and treatment alternatives to any ailment; d) ratings and information on all insurance and financial alternatives for health care payments; e) low-cost catastrophic care policies with large deductible; f) coverage for all pre-existing conditions.
Will require government requirements to pool insurance for patients with high-risk or pre-existing condition profile, subsidies (perhaps contributions to HSA's), tax deductible insurance for individuals as well as companies.
But key is patient empowerment.
Anything less, letting those who have no real sense of what Health Care is really about only leads to the situation we have now, where people are having a Health COST debate, not a Health CARE debate.
And that is, quite frankly, insulting and offensive to those of us who do need real Health Care Reform, and know that real Health Care Reform may cost more in the short term, but will cost less in the long term as more people's lives are saved, and suffering is reduced, and people who were once only fated for the morgue can now become real contributing members of society that we're all supposed to strive for, but many many people will never have the opportunity to realize because their HEALTH prevents them from participating in the economy and the world at large