Joe and I are obviously both reading the WSJ this week…
I’ve been watching the health-care debate with depressed fascination. It’s fascinating because this is our government in action, and because I believe that we need to make significant changes to our healthcare system – both for health and for economic reasons. And I’m depressed because what we’re being offered is just such a bad deal.
It’s a bad deal for a large variety of reasons, but the core one is that it intends to control costs through managing health care finance and through centralized regulation (which is also how healthcare finance – your insurer – will be managing your costs).
That model doesn’t have a great track record, here or elsewhere.
The best way to manage costs, I believe, is to engage patients as consumers to better manage their care – a trend which is also deeply embedded in the newest thinking about how to practice medicine. Health 2.0 is, among other things, about empowering patients and embracing the hyperinformed patient as a partner in their treatment.
It turns out I’m not alone.
The health-care bills moving through Congress contain little to reward consumers for lowering their health costs, an omission prompting some lawmakers to press for more such incentives.
Sen. Ron Wyden (D., Ore.) is proposing amendments to the Senate bill that would give people who are eligible for coverage through their employer the option of buying cheaper coverage from the new insurance exchanges — and pocketing the difference.
A bipartisan coalition including Sens. Ron Wyden (D., Ore.), Evan Bayh (D., Ind.) and Susan Collins (R., Maine) wants to let consumers pocket the difference if they can find a health plan cheaper than the one their employer offers, WSJ’s Janet Adamy reports.
The legislation, without the amendments, opens up the exchanges only to small businesses and to people who don’t have insurance through an employer.
Mr. Wyden’s proposal is garnering support from an unusual mix of lawmakers and interest groups. Maine Republican Susan Collins, whom the White House is courting to support the bill, and Sen. Evan Bayh, an influential moderate Democrat from Indiana, have signed on to the idea.
The National Federation of Independent Business, a small-business group that is opposed to the broader Senate bill, also backs the amendments because they would make insurance more portable, which would help people who wanted to leave their jobs to do something entrepreneurial.
There are virtually no provisions in the Senate or House health bills that directly reward consumers for choosing cost-efficient care or lowering their medical costs through healthy behavior. Instead, the White House and top Democrats who drafted the health bills focused on giving doctors, hospitals and other health-care providers incentives for reducing unnecessary treatments.
Ideas like this seem like nothing but good ones; insurance that makes all medical treatment free to everyone will lead to overconsumption of healthcare, which will in turn lead to rationing through explicit policy or rationing through waiting – as we see in Canada and the UK.
How do we provide government services without letting the Treasury get looted or without intrusive (and expensive) command-and-control bureaucracies?
The idea of giving consumers more “skin in the game” when it comes to health costs has long been popular in some academic circles, especially among those who believe market forces can help solve the U.S. health-spending problem.
From my point of view, we have three healthcare problems in the US – 1) horrible access to healthcare for the poor and uninsured; 2) a structural cost problem caused by rising healthcare costs; and 3) a demographic cost problem as the population ages. Nothing in the current proposals does anything about 2) or 3) which means that while the current bills will broaden coverage, it is highly unlikely they will ‘bend the curve’ and begin to make healthcare more affordable in the overall economy.
Personally, I’d rather directly subsidize HSA’s and empower people to make more – and one hopes better – decisions. Think of it as a ‘negative income tax’ for healthcare…
“I’m very troubled that the Senate bill does not empower consumers more,” Ms. Collins said. “If they’re given information and financial incentives, they’ll make good decisions.”