By Alice Rivlin (Brookings Institution) and Joseph Antos (American Enterprise Institute)
Post-Bulletin
March 29, 2007
We cannot stop the inexorable rise of health-care spending, but we should be able to slow it down without sacrificing the care we all want.
Progress can be made, but only if we get past the ideological debate over market-oriented versus regulatory approaches. Both markets and regulations play a necessary role in our health care system, and we must improve both. Giving consumers more understandable information about costs and effectiveness can help them choose more efficient providers and spend their health dollars more wisely, especially on routine or elective procedures. But a patient with a serious acute illness may not be in a position to make informed choices. Public and private insurers must adjust their payments to reward best practices and discourage wasteful and ineffective providers.
President Bush’s recent proposal to make employer contributions to employee health insurance taxable would discourage employers from offering over-generous health coverage that fosters wasteful health spending. The president would offer a standard deduction for health insurance to help taxpayers buy coverage either through their employer or in the market.
Congress should treat the president’s proposal as an opening bid, convert the standard deduction to a refundable tax credit available to everyone, and help the states make affordable coverage available to all through high-risk pools and more sensible regulation.
One thing is certain. Slowing the rise of health spending to a sustainable pace and getting more health for our money is going to take all of us. Patients and doctors, hospitals and insurers, governments and the private sector all have to work together. It won’t be easy, but unless we try everything and keep trying, we will have poorer than necessary health care at higher than necessary cost.
http://www.postbulletin.com/newsmanager/templates/localnews_story.asp?a=288963&z=12
Comment:
By Don McCanne, MD
The pressure is on for health care reform, and politicians and the policy community clearly understand that. The consensus seems to be that everyone should have the health care that they need, without having to face the added burden of financial hardship. That is a view from the political left that is now shared by an increasing number of moderates and even some from the right.
The right understands that changes are absolutely inevitable, and the lack of an enthusiastic reception of their concepts means that they will not be able to unilaterally dictate the policies to be adopted. The left understands that, at least until now, the rationality of a program of national health insurance has not been enough to drive reform.
Thus there has been a move to set ideology aside and to work together to tackle our health care problems. We are seeing unprecedented coalitions from across the political spectrum forming to advocate for comprehensive reform. Unfortunately, so far all that they have been able to produce is hot air, since they have not been able to agree on how reform is to be accomplished. That is, they have been unable to set ideology aside. (Massachusetts is not an exception, as it is an example of the process described in the next paragraph.)
So now we are seeing intellectuals such as Alice Rivlin and Joseph Antos trying to meet on a common ground while professing to set ideology aside. But where do they actually meet? Do they try to meet halfway between a government insurance program and private plans in the marketplace? No. They are meeting in the marketplace, deciding whether we’ll have private plans with modest regulation, or private plans controlled more by market forces. When universal health insurance is a concept from the left, why would we move over to the right to negotiate it?
The right will never give up their ideology. In insisting on market-oriented reform through private plans, they are willing to give up on covering everyone, give up on ensuring that people would get all of the care that they need, and give up on preventing financial hardship (since that is their most important tool for controlling spending).
Can the left set aside ideology? Not if we accept the position of the right that affordable, reasonably comprehensive health care for everyone is a left wing concept. But let’s try to do it anyway by redefining Medicare-for-All national health insurance as being as truly American as Mom and apple pie. American ideology is so much more comfy than partisan ideology.
