Health Reform: Who’s in Charge Here? Hint: It’s Not The Patients and It’s Not the Doctors

Over the past decade, we’ve enriched the labs, drug companies, medical device makers, hospital administrators and purveyors of CT scans, MRIs, canes and wheelchairs.   Meanwhile, we’ve squeezed the doctors, who don’t own their own clinics, who don't work as drug or device consultants or who don’t otherwise game a system that is so gamable. And of course, we’ve squeezed everyone oufside the system who stuck with the bills.

Steve Brill, “Bitter Pill: Why Medical Bills Are Killing Us,” Time Magazine,  February 20, 2013

Who is charge of the health system? 

It depends on who you ask. 

·         If you ask the business community, they will say the government, who under Obamacare is increasing their cost of covering employees by 20% to 30%. 

·          If you ask health plans, they will say something similar,  for they view Obamacare as a vehicle for raising their expenses while cutting their profit margins in the same order of magnitude, that is, by 20% to 30%.   

·         If  you ask the government,  it will say it is the medical-industrial complex,  that is, the health care markets, which keeps coming up with new technologies that cost more without any appreciable increase in efficiency or outcomes.

·         If you ask suppliers of health care services and  purveyers of medical technologies,  they will say they like government incentives just fine.    Their revenues have doubled  in the last five years are so.  AllScripts and Epic, who supply electronic medical record systems, are an example. For the last decade,  government has insisted a national interoperative data system  is imperative and has budgeted $30 billion to make it happenm and revenues of these electronic records systems giants have doubled.

·         If you ask physicians,  they will say it is a combination of government and private health plans,  which are intent on systematically lowering their reimbursements  and handcuffing them with regulations and codes that restrict what they can order and what they are paid.

·         If you ask patients, they are likely to say they have not idea but it isn’t them.    All they know is  tht they are faced with ever increasing premiums, unforgettable and unfathomable bills, catastrophic bills for catastrophic illnesses,  and a health reform law they do not understand  and that has so far cost more, lessened access, and caused them to lose employer coverage.

And so, the Great Debate over the future of government-provided  and free-market health cae rages on, without immediate resolution.

Writing today in Reuters, U.S. editiron,  Douglas Holtz-Eakin and Avik Roy, a couple of conservative economists say choosing between the two great forces – government which pays for 50% of heath costs, and private markets – who pay for care for most of us - is a false choice.  It is possible to have both with lower costs and more coverage.

They point to Switzerland.

While most Americans view their healthcare system as “free-market,” Switzerland actually has the most market-oriented healthcare system in the West. It translates into universal coverage and low entitlement costs. Swiss government entities spent about 3.5 percent of gross domestic product on healthcare in 2010, compared to 8.5 percent in the United States. That’s a difference of more than $5 trillion over 10 years: real money, especially relative to our $16 trillion debt.

There is no “public option” in Switzerland. Instead, citizens qualify for means-tested, sliding-scale subsidies and choose among a variety of regulated, private-sector insurance products. The Swiss have the freedom to choose their own doctors, as Americans do, and access to the latest medical technologies. They also have short waiting times for appointments.

Maybe it is possible to have the best of two worlds – private markets with government oversight and subsidies.

Think of health reform  as a huge and growing $2.8 trillion bitter lemon.  Government and health care industry is squeezing out the juices and leaving the hide to patients and doctors.

Tweet:  Who’s in charge of  paying for and causing high costs.  It’s a combination of government and the health care industry. It’s not patients and doctors.