Several years ago, I wrote a satirical article called “Who Killed Managed Care: A Policy Whodunit.” I identified the usual suspects, insurers, anti-managed care advocates, physicians, attorneys, etc., and concluded that the cause of managed care’s demise was self-immolation.
Sadly, since I’m a strong proponent of serious health care reform, it looks increasingly as though I’ll be able to write a sequel titled “Who Killed Health Care Reform—the 2009-2010 Version?” While the autopsy may be premature, it’s never too early to start identifying the usual suspects in this distressing sequel. Consider this post as just a set of preliminary observations (otherwise known as ranting and raving) on the unfolding debacle.
First, the politicians on both sides of the partisan divide have done a wonderful job of ignoring facts, fomenting fear, and generally failing to lead a reasoned debate of the issues. Nothing new here (though, perhaps, a healthy Senator Edward Kennedy could have made a difference), but primary responsibility resides with the ineffective and inept ruling democratic party. Throughout the process, the democrats have been outmaneuvered.
As I noted in an earlier post, I’m envious of the republican party’s discipline in its steadfast opposition to compromise. Shockingly, the republicans have been rewarded for its obstructionism. Deservedly, the democrats have been punished for how the legislation has been handled.
As a supporter of reform, perhaps the most disturbing aspect is the failure of the democrats to articulate why the legislation is sound public policy and will benefit many individuals and families who otherwise will see their premiums rise substantially and their benefits simultaneously reduced. One need only look to Anthem’s recent request for a 39% premium increase to get a real sense of the implications.
Even now, the absence of leadership is palpable. Where are the democrats, any democrat will do, who can talk to the public and counteract the opponents’ lies and distortions. From the canard of death panels to the mythical litigation explosion Tim Jost cogently noted in a recent post, the opponents have viciously, but effectively, distorted the legislation with nary a coherent response. To be blunt, the democrats continue to squander a large governing majority by acting as the minority party. What happened to the Mike Mansfields of the strong, confident democratic party?
Second, the media have already been deservedly criticized for their coverage, but it would be disingenuous to blame the media for the current mess that health care reform has become. To be sure, the media were slow to react to the lies that were being spread (i.e., the death panels). For whatever reason, reporters refused to call the distortions for what they really are–deliberate lies.
Also, the media failed to separate legitimate protests from the mauling of town hall events. Some have argued that the media gave the protesters too much attention, and hence credibility, but it’s hard to imagine the media ignoring the protests. Indeed, how could any reporter deal with people who don’t recognize that Medicare is a governmental program! And in fairness to reporters, the Obama administration and congressional democrats haven’t exactly made it easy for reporters to explain what’s at stake, what the key issues are, and what the overall costs of inaction will be.
Third, stakeholder behavior has hardly been forthright. For all of the dollars the pharmaceutical and health insurance industries have promised in savings, the probability is that they will benefit financially if health reform is enacted. That’s why Congressman Waxman, among others, objected to the proposed deals as inadequate. What’s interesting now that Billy Tauzin has resigned from PhRMA is whether the deal between PhRMA and President Obama will collapse. If so, does this give the democrats an opportunity to extend cost savings for pharmaceutical benefits and position the legislation as standing up to special interests?
In any event, these two industries could have acted voluntarily long ago to reduce costs and eliminate abuses, such as reducing administrative overhead, without waiting for the threat of health reform legislation. It’s both cynical and disingenuous for these industries to claim support when their evident goal is to derive financial rewards for minimal cost savings. More importantly, these industries have contributed to the morass we now face in ways that have been well documented. The economic rents the health insurance industry obtained in Medicare legislation enacted in the Bush administration is particularly galling.
Fourth, the American public should not be absolved. The culture of technology and general inability to accept limits make it difficult for policymakers to adopt sensible cost controls, such as comparative effectiveness analysis, and for insurers to deny medically unnecessary procedures.
Without doubt, all of the above has contributed to a dispiriting debate that has obscured the reality of how badly the health care system needs to be changed. As President Obama has argued, retaining the status quo will result in lower insurance benefits and higher health care costs, leading to steadily larger numbers of people without health insurance.
Then who or what is the culprit? In my view, the primary reason for the apparent failure to enact legislation is the sheer complexity of the health care system. It is incredibly difficult to explain how the system works to average Americans, especially those who have employer-sponsored health benefits. No matter how desirable health reform seems to many, it can’t overcome the public’s fear and the general lack of understanding of how health care is financed and delivered.
Even health policy scholars can have a difficult time explaining why reform is imperative, what the consequences for individual health care will be absent reform, and how the proposed reforms will likely affect individuals and businesses. In short, the public is so polarized that high-quality analysis and reporting are simply overrun by innuendo, distortion, and the sheer complexity of reforming the health care system.
I have argued in earlier posts that the Senate bill is worthy of support, even though it is hardly an ideal approach to health care reform. As the health care industry absorbs an ever-increasing share of GDP and becomes increasingly fragmented and complex, the ability to enact meaningful reform legislation will only become more difficult.
On an academic level, it is fun to pontificate about who lost health reform and why. But make no mistake, the consequences of failure are serious. In all likelihood, it will be another generation before the opportunity to enact meaningful reforms will come again. In the meantime, the losers from the debacle far outnumber the winners. The irony that many of the most vociferous opponents of reform (i.e., the Tea Party adherents) may be among the biggest losers offers little consolation for those who will benefit from enacting legislation now.