MSNBC Opinion
December 21, 2001
“Bioethics: Congress needs to administer strong medicine”
By Arthur Caplan, Ph.D., Director, Center for Bioethics at the University of Pennsylvania
“Events of the past year demonstrate beyond a doubt that managed care has failed – and failed dismally. The greatest single ethical crisis facing American health care as we move into the new year is what to do about it.”
(Dr. Caplan presents “the grim statistics” and concludes as follows.)
“Managed care is acutely ill. It is not doing the job the American people asked it to do. Congress should be paying attention but it is not.
“The end result: It is costing you and me an enormous amount of money to keep the current mess afloat.”
“THE SOLUTION”
“It is time to start to treat health care for what it is – an essential public good that is not simply a business, or a perk of employment or a matter of charity.
“Congress should create a commission that meets in public and would have the power to control price increases, limit deductibles, insist on access, and ensure the quality of care that managed care provides. The commission should solicit consumer complaints and work with federal and state officials to resolve them. And the commission should have the power to mandate coverage of health care benefits.
“The Clinton plan died because it gave government too big a role in health care. Managed care is dying because government has too small a role. Congress needs to administer some very strong medicine to managed care – and fast.”
Comment: Dr. Caplan describes well the dismal failures of our health plans in establishing health care as an essential public good. His proposed solution is interesting. He recommends a government commission that controls prices, prohibits excessive cost shifting to patients, mandates access, provides quality oversight, and mandates coverage of health care benefits.
His recommended list of government controls is not dissimilar to the controls that have been placed on the Medicare + Choice options. The experience with this program is instructive. Although the plans have had some success in using marketplace tools to circumvent some of these controls, overall they have not been successful with their primary assigned purpose, controlling health care costs. So these plans are now back before Congress, with hat in hand, begging for more funds while pulling out of unprofitable markets.
In spite of the clear need to improve the benefits of the traditional Medicare program, 85% of Medicare beneficiaries remain in our more efficient, publicly administered program that still offers free choice of providers. No matter what demands are dictated by a government commission, marketplace plans will continue to subvert the intent to establish health care equity. The experiment has already been completed and the results are in. The plans have proven that they need to be dumped as the failed model that they are.
Dr. Caplan calls for a role of government in health care that is neither too big nor too small. Americans don’t want a system of socialized medicine, so we should leave the providers of health care in the marketplace. Let them compete for patients. But the goals that would be set by Dr. Caplan’s commission would be realized much more efficiently and effectively by a publicly administered program of universal health insurance. The traditional Medicare program has already proven this. Let’s get on with fixing Medicare and then providing it for all of us as a single payer system.
We can control costs through global budgeting and rate negotiation. Providers would compete with each other for control of the resources. But the struggle would be over efforts to provide more and better care for patients, within the constraints of a very generous budget. You do not have to be an ethicist to understand the superiority of that model over our current system that is designed to deprive care in the name of profit.