Skimming the news this morning, I came across this editorial. It’s about health care reform and an apparent coming push from President Bush in his State of the Union address. There are several angles to this, all of which the writer approaches. The whole piece is so discombobulated that I can only offer a few bits and try to make a little sense out of them, which is something I think the writer forgot. Consider this opening paragraph:
This time last year, President Bush was preaching Social Security reform; that got nowhere. This time six months ago, his team was thinking tax reform; it soon got cold feet. Now the new theme is health reform. “This is a big priority for the president,” Al Hubbard, the White House national economic adviser, told me Friday. “The system has got to be reformed.”
If that’s the path President Bush is going to pursue, there’s a lesson in how leaders (leadership in character, not title) behave. Flip-flopping around to every new issue, hoping to make a mark, only to abandon it when it becomes apparent that it might be challenging is not the mark of a good leader. A leader sets his course and then moves in the direction of its achievement. That clearly can’t be said of Social Security and tax reform, so I fail to see how health care will be different. But let’s continue:
Some look at the U.S. health mess and see a failure of the market, but the authors [R. Glenn Hubbard of Columbia University and John F. Cogan and Daniel P. Kessler of the Hoover Institution] insist that government clumsiness prevents the market from working. Modest tort reform would free doctors from practicing expensive defensive medicine. Tougher antitrust policies would prevent price-raising alliances among hospitals. Pruning mandates on health insurers — which often reflect lobbying by doctors’ groups — might free insurers to cover only the most cost-effective procedures.
Enter the authors’ really big idea — the one on which the White House is likely to build a story about its grand health-reform vision. To make the health market work, the trick is to create and then empower consumers. You create them by making individuals pay more out of pocket. And you empower them by forcing hospitals and doctors to publish information on quality and price.
As I read this I thought this plan might be a start. My experience backs up much of what they’re saying in some form. Essentially, I read this as a way to make the free market work. Wherever an obstacle exists, figure out a way to remove it. Mostly, I see the government’s role as removing governmental obstacles to free market success. Beyond that, a solution that involves individuals in making choices relavent to them is the most logical. One specific example I’ve offered in the past is breaking the paternalistic link between employer and health care. Mr. Hubbard seems to propose that with an imaginary scenario.
The idea appeals to Al Hubbard, a bluff, no-nonsense business type with a genial, uncomplicated style. Hubbard invited me to imagine a world in which companies paid for their staffs’ groceries: Employees would load up with more food than they needed; supermarkets would seize the chance to mark up groceries; pretty soon, they wouldn’t even bother posting their prices. So it is today with medicine. You don’t know the cost of your hospital visit until a few days later, when the bill arrives.
Too extreme an example? Possibly. Too far-fetched? I don’t think so. The writer goes on to explain a supposed weakness in this. I’m simplifying, but he posits that the system is too complex, whether for consumer intelligence or consumer knowledge for decision-making. Throw in a dose of “people won’t take care of themselves” if they have to pay for it, and the proposed outcome starts to take shape. The market works, but only if people are smart, which leads to this conclusion:
Beyond the imperative of restraining prices, the biggest challenges in health care are to get insurance to everyone and to create incentives for preventive treatment — even though prevention may pay off 30 years later, by which time the patient will have gone through multiple switches in health plans. The most plausible subsidizer of universal insurance is government, and the only entity with a stake in lifelong wellness is the government. Is the administration ready to see that?
Somehow we’ve gotten to a situation where waste, inefficiency, and bureaucratic largess resulted in a health care crisis in need of urgent reform. The logical conclusion is to hand that over to the government to eliminate those problems? Are we talking about the same government? The United States government? I would not have come to that conclusion, although I fear the Bush administration will. (See: prescription drug benefit) Right, great idea.