Tuesday, February 23, 2010

Do-or-Die - Partisan Season for Health Reform

Preface: When one political party claims the other party is devoid of ideas, we are in the political partisan season. Each party has ideas. One says government should control care. The other says let the market decide. And never the twain shall meet.

I prefer the market approach, as expressed in the following report from The American Enterprise Institute. One of its authors is Joseph Antos, a PhD economist.

I interviewed him for my 2005 book, Voices of Health Reform, and I respect his opinion.

Here is an executive summary the American Enterprise Institute's report,

A Better Prescription:
Realistic Health Reform

By Joseph Antos, Thomas P. Miller, Resident Scholar and Resident Fellow, American Enterprise Institute

February 23, 2010

Executive Summary

"After a year of political wrangling and two thousand-page bills that promise more than they can deliver, it is time for a more prudent approach to health care reform. Americans made it clear that they will not tolerate a top-down health reform that further centralizes power and decision making in Washington. They distrust the promises of lower cost and more secure coverage, and they fear losing what they have now."

"A new approach to reform is needed, one that levels with the American people about what is possible and what is necessary. The better prescription requires that we rethink both the goals and methods of health reform."

"• We must set realistic priorities for reform. We have neither the resources nor the wisdom to solve every problem in the health system through one grand legislative act.

• We must take measured steps to reform the health system, allowing for frequent midcourse corrections as we learn how the system reacts to policy changes. We cannot anticipate every contingency and prevent every adverse consequence, no matter how many experts we consult or pages of legislation we write.

• We must recognize that the success of health system reform depends crucially on the way individuals, health providers, employers, and others respond to changes in incentives. Government can act as a catalyst for reform without attempting to dictate the results.

• We must recognize that the ultimate objective is to help Americans achieve healthier, more productive lives. Much of the responsibility for accomplishing that goal will rest with individuals, and their actions can be taken with no changes in government policy."

"The following describes targeted actions that should be adopted by Congress as part of a broad health system reform effort."

Number One: Place the Money--and Greater Control--in Consumers' Hands

"• Replace Existing Tax Breaks for Health Insurance with Tax Credits.

• Promote Better Health Insurance Choices.

• Promote Information to Help Patients and Their Doctors

• Make More Informed Treatment Decisions.

Number Two:
Align Expectations with Reality

• Promote Effective and Fiscally Responsible Competition in Medicare.

• Provide More Predictable Funding for Medicaid.

Number Three: Create Accountability in the Health System

• Provide Better Access to Affordable Private Insurance.

• Develop Better Ways to Pay for Health Services That Reward Superior Value.

• Reform the Medical-Liability System.

• Promote Personal Responsibility."


Market-based health reform provides the tools by which the health system can become more effective, more efficient, and more responsive to patient needs. It relies on financial incentives rather than central direction and control, and it recognizes that a one-size-fits-all approach will not work in a country as diverse as ours. Unlike a top-down approach, market-based reform fosters accountability throughout the health system."

"A market approach is no panacea, but it does not claim to be. It does not make promises to immediately solve every problem. This approach offers something better: a framework for continuing health system innovation and improvement whose strength lies in its flexibility and ability to adapt to change. This is the only real prescription for sustainable reform of our health care system."

Joseph Antos, PhD, is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI. Thomas P. Miller is a resident fellow at AEI.

And here is my closing limerick,

Obamanites claim the other side has no suggestions,

No real answers to the big health reform questions.

The other side says it has plenty of good proposals,

But Obamanites file their ideas under “disposals.”

These positions don’t lead to bipartisan digestions.

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