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Share this pageSteven Brill on using single payer to “clean up the system”
Posted by Don McCanne MD on Thursday, Mar 14, 2013This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.
Experts debate all-payer setups vs. Medicare for all
By Brett Norman
Politico, March 14, 2013Health care prices are too damn high.
That’s the punch line to the provocative Time magazine piece “Bitter Pill” by Steven Brill, who laid out his diagnosis of the problem Wednesday at a Center for American Progress panel.
He cited sky-high hospital executive salaries and operating margins, monopolistic and opaque pricing by providers and a fearsome lobbying force — many times larger than those of the oil and gas or defense industries — that has beaten policymakers into submission.
“The lap-doggery to the health care industry is bipartisan,” he said. The article has sent hospitals and other stakeholders to the wall in defense of the system, and it’s fueling debates in policy circles.
But while many policy experts agree with much of Brill’s diagnosis of factors that are driving up costs, there’s far less consensus on what to do about it.
Brill said the voluminous feedback he’s received since publishing the article breaks down along two lines. Conservatives believe consumers need to have more “skin in the game” — to pay more of health costs so they become more conscientious shoppers and put pressure on providers to more efficiently compete for their business. And liberals see the solution in Medicare-for-all, a single-payer system, amplifying the negotiating might the federal health care program already leverages to keep costs down.
Brill rejected the single-payer possibility as impractical in his article but now says that he is increasingly siding with that camp. “It’s sort of the cleanest way to clean up the system,” he said.
Brill believes that the federal health care law in general does little to control costs and will most likely drive up the cost of insurance because of new requirements for more robust coverage.
He gave little credence to the Beltway policy wonk goal of transforming the health care system away from paying for quantity of services provided to paying for health outcomes and the quality of care. He said similar efforts to move the legal profession away from billing by the hour and toward meeting performance benchmarks have either failed or proved more expensive.
http://www.politico.com/story/2013/03/experts-debate-all-payer-setups-vs…
Steven Brill provided such a convincing argument for using Medicare as a universal program to control health care spending that he now seems to be convincing himself that we should look beyond the current approach of dismissing single payer as impractical. As he says, single payer is “sort of the cleanest way to clean up the system.”
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Barbara
March 24th, 2013 at 10:44 am
To use a reference from Don’s comments on the Brill article (and related commentary):
“Other effective policies include global budgeting of hospitals and institutions. Rather than having complex, detailed billing for each medical encounter, hospitals would operate on global budgets just as our police and fire departments do now.”
I have been unsuccessful in convincing colleagues, citizens, and legislators using the Police/Fire department analogy. Two immediate issues arise:
1. Some folks know that their police and fire department budgets are being cut and that services, therefore, will be curtailed.
2. Some (myself included) just cannot make the jump from something as intimate as medical care — and its associated budgeting — to Police and Fire Department services.
I GET the financials here; it’s not that. I understand the budgeting process, and the financial concepts inherent in global budgeting methods. Yet I receive looks of total confusion as soon as I use the Police/Fire department analogy. People’s faces take on a look of consternation and a “what did you say?” expression.
I wonder if this difficulty is due to the vast (perceived) differences between what healthcare providers do, and the relationship between provider and patient, versus the utter lack of relationship individuals have with police and fire department personnel?
I have resorted to simply talking about Operating Budget concepts based on costs and necessary investments for capacity planning, etc. I’ve learned not to compare to Police and Fire departments as I lose my audience very quickly.
Respectfully submitted,