Let Insiders Make Health Deals

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.

Comments

[Philclock]

You're missing the point.

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.

[Jim Jaffe - Huffpost Blogger]

I may be missing the point, but it appears to me that providers do control the system and patients are rather passive participants. That isn't surprising because they tend to be sick, scared and appropriately reliant on the medical expertise they are hiring. While I couldn't agree more with you argument that providers should be competing to provide efficient care, we've a long way to go before we can define precisely what efficient care is, let alone provide a map for getting us there.

[Philclock]

My oncologist friend agrees with you, health care such an emotional decision with lives on the line.

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.

[wethepeople3884]

Fact is I can't seem to comprehend nor can anyone explain the service that insurance companies actually provide. They don't help the patient. They don't help the doctor or the hospital administrator and they certainly don't help the medical receptionists. They cause SOOO many problems but what is their purpose and their function? Obama said we couldn't just rip up the system and start from scratch but the system is a train wreck. We certainly could have started from scratch. In fact, we still can but no one seems to be intelligent enough to do it. Seems to me that a country that is so enamored with precious capitalism would have no problem allowing useless businesses to fail and yet, we are have done everything within our power in the last year to keep those corporations who have gutted this countries economy in business. I never met him but I dont think this is what Adam Smith had in mind when he talked about the invisible hand but of course, a country that denies the existence of natural selection which was used as Adam Smith's central theory in capitalism could never be expected to think logically about such things. In reality, Corruption and Stupidity seem to be the underlying theme in all our failures so I believe there are only two required pieces of legislation to be successful again - major reform and strict regulations on capaign/lobbying funding and massive funding increases in the American education system.

[Jim Jaffe - Huffpost Blogger]

near as I can tell, insurance companies -- whether in the health, homeowners, fire or auto businesses-- pay large unexpected expenses that policyholders would be unable to afford otherwise. Like if my house burns down. or need a $100,000 hospital stay. that makes sense to me. whether insurance companies should help pay doctor bills that cost less than $100 is a good question. after all auto insurers don't pay for new windshield wipers or headlights, tho both help us avoid accidents.

[wethepeople3884]

True but when you start making concessions with insurance companies like they dont need to pay for fees under 100 dollars, they will abuse that. They will tell cancer patients that they can't cover any of their 7 visits to the hospital that week except for the chemo because all of the doctor bills were under 100 dollars. That adds up in a big way for those with chronic illnesses. And insurance companies won't stop there- i just thought that up on the top of my head, They will go out of there way to find every nook and cranny in which they can abuse every law that congress makes to restrict them or to help them. So I wouldnt go and provide insurance with an escape latch that I found about 2 seconds after reading your post. I think if we cant get this public option because congress is clearly corrupted by the insurance industry, then, congressman must make very tight regulations on everything so that they basically have a strangle hold on insurance company profits. There is no other way to reign in profits and decrease expenditures in any major way unless there is a competing non-profit public option or strictly enforced restrictions on everything they make and everything they charge.

[wethepeople3884]

"giving a larger role to allegedly value-free bureaucratic mandarins who'd decide what type of care is appropriate." A bureaucratic mandarin? That sounds like an American-Chinese fusion platter. Does anyone in this country not have some vested interest in this debate? There is no unbiased observer because everyone will be affected by the outcome of this bill - the entire government, the american public, the media, everyone! And wasn't the whole original republican slogan - you dont want beauracrats deciding what type of care you get. And you so eloquently put bureaucrat and care in the same sentence as a proposed solution? I would hope any bureaucratic mandarin would be someone who had an MD if they are deciding the type of care thats appropriate. If we locked everyone with an interest in this room, it would have to be some room. I don't think a football stadium could hold us all.

[Jim Jaffe - Huffpost Blogger]

well, doctors are basically deciding what care we get today and costs are totally out of control. if you like that system, we should stay with it. As Peter Orszag and others point out, each year the cost and complexity of treating any given condition increases without any resulting increase in health status. this care creep is a real problem. and doctors as a class are not being very aggressive about solving it.

[wethepeople3884]

Im in medical school so I do have some background knowledge here Jim. One, doctors train for four years just to get an MD and then, another 3 to 7 years in order to start practicing on their own or be an attending. That is somewhere between 7 and 11 years or very extensive, broad and comprehensive training right there. That is why people trust doctors with their lives. Not just as a future physician but also as a future patient, I do not want government beauracrats or insurance administrators determining the doctors course of treatment. As a patient, I would fear for my life if I knew this was happening to me and I know insurance does do this in many cases right now. As a doctor, I would wonder why exactly we are studying and training so hard if we don't even make the decisions at the end of the day. Doctors salaries are not even close to the contributing factor in skyrocketing medical costs - Insurance companies are making billions in profits each year on average increasing by about 400 percent per year. That is HUGE in contributing to the problem. They provide no service, force patients to pay for coveragand then, try as hard as they possibly can not to cover patient treatment so they can increase those profits to a growth rate of 400 percent.

[wethepeople3884]

Billions is quite some profits when the ultimate function of insurance companies is merely to be payed and then, pay for treatment when it is required. Except insurance has no incentive to cover patients for ANYTHING. They actually have incentive to deny claims in every possible case they can and are even rewarded for it. This is why a 400 percent growth rate occurs. Then, they are using some of this to give millions to congress to pass tort reform and call it healthcare reform. In fact, all we need is health insurance reform b/c ultimately they are the only problem. Drug companies are also charging exorbitant prices to earn a profit and not working for the patient but for their bottom line. The two of them together have contributed or all the sole contributor to this skyrocket in healthcare costs - the costs are not just paying doctors, paying for drugs and paying for procedures­/surgery/T­ests. They are contributing to billions in insurance profit and massive drug costs because of deregulation. I am basically for anything that lowers costs right now - the gov't wants to do the option, regulation, subsidies, price restrictions, taxing, tort reform, something else or all of the above, I will support it because I think we should start with everything, see what works to control costs and then, tweak the legislation here and there afterwards if need be.

[wethepeople3884]

I would like to know when you get a chance what exactly do you think physicians could do to control costs? I guess tort reform could stop some unnecessary tests and procedures and stop doctors from practicing defensive medicine but this situation is no all that common as far as I can tell. Doctors may do a few unnecessary things here and there but in the end, we are taught that it is far better to be safe and do the extra procedure then, not do it, have the patient call up in a month and tell you that they have lung cancer and you missed it because you didn't do that test you were thinking about. Medicine is complex - we cant just take a history and physical and blood test and immediately know exactly what we are looking for. Sometimes, an x-ray is indicated but may turn up nothing. Sometimes an x ray shows something minor and a CT or MRI is in order. Sometimes, we can do all of this, not find anything and be forced to do a biopsy or aspirate or more invasive procedure to rule out certain things. Medicine is not cut and dry - it is complex and difficult. It requires prior knowledge, investigation, interpretation among other things. Sometimes it requires you to play the role of a detective before you really know whats going on.

[jazzman]

Expanding Medicare would have been so simple and so effective. It wouldn't even take writing a new set of rules since the rules already exist. I guess using the wheel that is already invented and proven to work well is beyond the ability of our political system.

[Jim Jaffe - Huffpost Blogger]

it would have been very simple, but not easy because the Health Fairy was unwilling to pay for it and no one else volunteered. Given the fact that the existing Medicare program is on the cusp of bankruptcy, I don't know whether it would make a lot of sense to expand it unless a new revenue source was available.

[Frim Fram Sauce]

I was just thinking this the other night this is going to be the tax code all over. With all of the pieces and parts it is doomed to fail and it will take years and years to massage it into anything workable. One thing you can bet on is, it will never be anything that favors the working class (we only get crumbs).

[Jim Jaffe - Huffpost Blogger]

interesting analogy. each time we revise the tax code the number of working people paying income taxes declines. the percentage of the workforce paying income taxes is now substantially lower than it was 20 years ago. perhaps that's just a crumb, but not an insubstantial one.

[PlaceboStudman]

If anyone was really, truly serious about Health Care Reform...and I say here and now, that no one is...the people who would be in charge of the reform are the people who need it most. The disabled, chronically and critically ill, and our families who have our best interest in mind.

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

[Jim Jaffe - Huffpost Blogger]

interesting in that similar logic was used to construct the poverty program and it turned out the poor weren't all that expert about how to do economic development and create jobs. asking sick people to take time out to reinvent our health system seems like a bit of a stretch to me.