With the way recent media coverage, advertising, and politicians are framing the health care reform debate, many Americans are confused. Fortunately, there are many reliable sources of information between all the smoke and mirrors that Congress has created, such as Dr. Jeffry Flier, Dean of Harvard Medical School.
In a recent article in the Journal of Clinical Investigation, Dr. Flier correctly asserted that good health care reform must be treated like good medicine: identifying and treating the cause as well as the symptoms.” The current proposals from Congress however, “are the wrong therapy because they mistake the symptoms for the underlying disease.”
Americans all know what the ‘symptoms’ of our inefficient health care system are: “rapidly growing health expenditures, diminished access to affordable insurance causing many to be uninsured, and inadequate quality and outcomes for the dollars spent.” Dr. Flier identifies three reasons why these ‘symptoms’ exist.
First, has an inefficient and inequitable system of tax-advantaged, employer-based health insurance. According to Flier, “the federal tax code promotes overspending by making the majority unaware of the true cost of their insurance and care. Moreover, “the code is grossly unfair to the self-employed, and small businesses, workers.”
Second, “health care markets rarely conduct successful experiments with new ways of paying for and organizing health care delivery … because health insurance markets suffer from overregulation that limits innovation in both insurance and new ways of delivering medical care.” This hurts patients and consumers because real progress depends on this collaboration between industry and academia.
Third, enormous and uncontrollable programs like Medicaid and Medicare have “led to rising expenditures decoupled from better health, and obligate massive future deficits that everyone agrees are unsustainable.” While these programs may deliver health care to the poor, disabled and elderly, they are also filled with fraud and abuse because the “programs pay providers by administrative pricing formulas that are well documented to promote both overuse and underuse of appropriate care.”
As Dr. Flier correctly asserts, “the current political debate and the several and incomplete versions of “reform” proposals do little to address these core problems.” Specifically, creating a new public insurance program would guarantee future problems of fraud, abuse, and uncontrollable spending. In order to address the present problems with government run health care, medical innovators need more say in how to “correct the acknowledged fiscal and organizational flaws of Medicare and Medicaid, while making it possible to make changes rapidly without such a tedious political process.
Other proposals that claim to both increase quality and reduce costs are also farfetched. To control costs, Congress would create a new executive branch commission that would “centralize power” and basically decide how much to spend, how to spend it, and who gets it. What is needed is a system that will allow “new advances in diagnostics, therapeutics, and devices over the coming decades … to flow from a decentralized and innovative health care market.”
Consequently, Dr. Flier offers some adequate suggestions the public should ask their representatives to consider before taking any further action. First, he wants all ideas for new health care systems to be run as pilot programs, and only extended only if data reveal the desired outcomes. Second, “reform needs to make the tax shelter for health insurance independent of employment because it would enable the uninsured to use tax-sheltered money to buy health insurance for themselves while permitting insured employees to become more central in decision making.”
Third, and probably most important for improving care, is that reform needs to “identify and eliminate the many barriers to entry and innovation in the health care and insurance marketplace. If reform can remove “hidden barriers to competition it will encourage entrepreneurs to offer lower-cost ways of financing and delivering health care.”
Fourth, if Medicare and Medicaid enrollees are given earned income credits, “the sicker and less affluent would receive larger transfers, so they can buy adequate coverage … which might break the logjam in payment reform and reliance on fee for service and centralized price controls.”
With at least three separate proposals on the table for health care reform, the process has only begun. With prominent health care experts such as Dr. Flier calling for new approaches from Congress Americans need to make sure their politicians on every level are aware that rushing health care reform will only create more problems in the future. If politicians rush to vote on the present bills to address problems now, it will be like putting a band-aid over a bullet wound: it might stop the bleeding temporarily, but it will not keep you alive very long.
Any reform proposed should certainly be tested first. If such ideas are shown to be effective at reducing costs, fraud, and abuse, while improving effectiveness, treatment and care, and creating innovation between industry and academia, only then should it be approved. Those should be the standards for all patients and consumers to consider when considering whether reform will help them tomorrow, or today.