Taking A Flier On Health Care “Reform”

“Take a flyer”

Idiom Meaning – To Take a chance or a risk

Jeffrey S. Flier, the dean of Harvard Medical School,” give health care “reform” a “failing grade” in today’s Wall Street Journal.

In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care’s dysfunctional delivery system….

Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.

In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system—now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all….

Dr. Flier also insists that there are important lessons to be learned from the experience in Massachusetts with insurance mandates similar to those proposed in federal legislation that “succeeded in expanding coverage but — despite initial predictions — increased total spending.” A “Special Commission” there has proposed replacing the current fee for service system with one where payments will be “capitated.”

Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change—necessitated by skyrocketing costs and a desire to improve quality—are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.

Yet it’s entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire. Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law.

Flier notes that it is a “challenging task” to sell such “an uncertain and potentially unwelcome” restructuring of our health care system honestly.

It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation.

So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.

We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.

What we are facing, in short, is a health care reform shell game conducted with stealth, disingenuousness, and deception. Why is that no longer a surprise?

Say What?