Monday, June 26, 2017

Missing the Bigger Picture

Saw some interesting observations about health insurance reform in the news this past weekend.  First off is James Davis:
James Davis, who runs communications for the Koch network, lamented that the conversation on health-care reform has focused too much on the number of people who have insurance — regardless of premiums or what kind of care those who have it will receive — and not enough on outcomes.
Hard to argue with looking at outcomes.  I spent my entire professional career evaluating the results of public programs and know that, in the end, public programs should produce the desired results.  I also know that identifying and measuring those results can be difficult, but health care has some definite outcomes for for society as a whole.  Mr. Davis is right to ask about results.  It would not take long for him to find that:
 The United States health care system is the most expensive in the world...[and]...underperforms relative to other countries on most dimensions of performance.
Mr. Davis did not say how he would define health outcomes but his statement suggests that he would encourage the Koch brothers to look for ways to promote improved performance at lower costs.  He may not need to do a great deal of research.

Perhaps a magic free market Koch brothers-approved system will change the trajectory of American heath outcomes but I doubt it.  So far, the most successful system the US has come with was the Republican-inspired Affordable Care Act and the Republicans HATED that.  It did reduce the number of uninsured but insurance does not guarantee actual health care.  On the other hand, the ACA did little to reduce costs.  It definitely needs work but I don't have much faith in the Koch's free market libertarian solutions. 

Also in the news is Pennsylvania Senator Patrick Toomey defending a change in the funding formula that will index Medicaid payments to the states to changes in the overall consumer price index rather the typically higher medical price index:
"The idea that there’s a sector of our economy that has to permanently have a higher inflation rate than the rest of our economy is ridiculous,” Toomey said Thursday. “I think that it’s absolutely essential to putting [Medicaid] on a sustainable path so that it will be there for future generations.”
Senator Toomey said the change was needed to “transition to a normal inflation rate” for a program in which he said costs were spiraling out of control.  Here, too, I can't argue with his underlying premise.  Program costs should not spiral out of control.  But he would simply refuse to address the causes of those spiraling costs.  Instead, he would fund Medicaid only to certain point regardless on the impact it will have on access to medical insurance (which may not guarantee health care but is a sine qua non for any hope of obtaining medical treatment).  When the funding runs out so will insurance coverage for many.

What neither of these men seem to wonder is why American health care costs are spiraling out of control even as the country spends far more per capita than any other nation.  This is a complex question that deserves considerable debate and discussion.  It is not a question that can be crammed into partisan legislation and voted on the quick-time.  Of course, in today's Congress, partisan legislation enacted in haste is exactly what we will get.


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