We dare not follow
Bush, Frist, Thomas have healthcare dreams
others might call nightmares
Story originally published January 31, 2005
Written by Todd Sloane, Assistant Managing Editor Op/Ed Modern HealthCare
Visionaries see problems differently than the rest of us, conjuring up solutions we ordinary folks could never divine. These are essential people, and yet there are times to beware of them, such as when they are thinking of running for president or are feeling the pressure of term limits. At such times be very cautious about following them. You could fall off a cliff.
Healthcare providers and their patients are treading close to such an abyss. President Bush, Senate Majority Leader Bill Frist (R-Tenn.) and House Ways and Means Committee Chairman Bill Thomas (R-Calif.) are dreaming the dreams of men with near absolute power and a short deadline.
Frist, who has promised to retire from the Senate in 2006, may be floating a bit higher than the others, having recently revealed his vision of healthcare in the year 2015 in of all places the New England Journal of Medicine. His alien dream is filled with accounts of injected nanorobots that detect and fix cancers and implanted radio frequency devices that continuously monitor goings on in our abdomens. At the head of this brave new healthcare system is the informed public, presumably the same erudite masses that would send the good Dr. Frist to the White House in 2008.
Not all of his visions are out of “Fantastic Voyage.” He returns to terra firma long enough to call for an end to tax incentives for employers who offer health coverage, which would effectively end that insurance system. The credits would go to those all-powerful individual citizens, who would brave the private insurance market armed with the latest outcomes and clinical research data. Mind you, he has no plans to end the current discrimination in that market against anyone who has actually been sick. Bemoaning the fact that the average family policy now costs $9,000 per year, Frist wants to come to the rescue by promoting health savings accounts as a panacea. It seems that paying a far lower premium but shelling out $5,000 to $10,000 from your pocket for these catastrophic policies is much more “empowering.”
Thomas’ ideas come wrapped in less interstellar prose, but the net effect is much the same. The chairman, who would lose his coveted post under House Republican rules in 2007, has his eye on the infernal payroll tax that funds Medicare and Social Security. The tax discourages hiring, Thomas says, and he hints at lowering it or scrapping it in favor of an income tax, either of which would lead to cuts in benefits or an increase in the retirement age. A less onerous method of trimming Medicare costs, of course, would be to allow HHS to negotiate prices for the new prescription-drug benefit with drug companies, but that is off the table. Apparently, the “ownership society” that conservatives love to talk about does not allow for such government interference, even in a marketplace the government itself established.
President Bush, meanwhile, still has Medicaid firmly in his rifle sights as he staves off the lame-duck label. His brother Jeb has proposed privatizing the program in Florida, handing poor beneficiaries a check they can use to brave the managed-care market, which I am sure will be thrilled to have them. The prez won’t go that far on a national basis, but he will try to cap spending on a program that has been rising in cost but at a significantly lower rate than overall health spending. His favorite buzzword here is “flexibility” for state programs, a word that for providers and patients translates roughly to “screwed.”
All these visions have me swooning, a state that many providers may be experiencing as well. I wonder if my employer-sponsored insurance plan covers this condition. If you have a health savings account, you may want to just lie down.
