Health Reform Gets Messy

Politico is running a story about how health reform in Massachusetts has gone awry (http://www.politico.com/news/stories/0612/76991.html). Excerpts:

Gov. Deval Patrick wants Massachusetts to “crack the code” on health care costs, a punchy slogan he uses when he’s promoting nationally the Bay State’s cost-containment efforts. But transforming his ambition into policy has produced some messy sausage-making in his state Legislature.
Key stakeholders aren’t sure whether the springtime rush to craft a state approach to health care costs will create a national model — much the way Massachusetts’s 2006 coverage expansion signed by Gov. Mitt Romney helped create a framework for President Barack Obama’s 2010 national health law. In fact, some are wondering whether the cost-savings effort will even work in Massachusetts.

Hospitals, doctors and insurers have ferociously lobbied to protect their industries, and lawmakers crafting the bill are feeling the effects of the tug of war.
“One thing we have learned so far is that it’s a lot more complicated than just expanding access to health coverage,” said Sen. Richard Moore, a Democrat who helped negotiate the contours of the 2006 law signed by then-Gov. Mitt Romney and is now helping shape the second stage of Massachusetts reform.

Patrick, an Obama campaign surrogate, has argued that solving soaring health costs in Massachusetts could vindicate the national health law. Romney, on the other hand, has taken flak from conservatives for fathering Massachusetts’s health care law — particularly its individual mandate. And while he has vowed to repeal the federal health law, he’s defended the state reform, arguing that it’s popular and hasn’t added much to the state’s fiscal burden. A successful cost-control effort could lend credence to those claims.
But that doesn’t solve the question of whether the effort will be successful.

Jonathan Gruber, an MIT economist who advised the Legislature and Romney on the 2006 Massachusetts law, pleaded with stakeholders to accept that curbing health costs takes time.
“We don’t know the answer. We don’t know how to fix it now, and we have to experiment and be more patient,” Gruber told a health care conference in Boston in late May. “It’s like global warming in the sense it took a long time to get us as screwed up as we are. It’s going to take a long time to fix it.”

Gruber was interviewed on MSNBC's Hardball in March 2012 (http://www.msnbc.msn.com/id/3036697/#46873470):

MSNBC
March 27, 2012
Hardball with Chris Matthews

Chris Matthews: Single payer. Is that a better economic deal, with no profit motive?

Jonathan Gruber: I think that single payer, if you could start over, I think that single payer has a lot to recommend it, but we can't...

My comment:

Prof. Gruber does not know what to do about health care costs, largely because he decided in advance that he (and therefore we) can not "start over", by which he means that we can not take a look at how other nations get better quality health care at a lower price. As long as one begins with the premise that no real change is politically feasible, then health care reform devolves into an ugly political mess with hospitals, doctors, insurance companies, medical device manufacturers, drug makers, etc. all ferociously lobbying to protect their interests. Notice, however, that no one is lobbying for patients. This is the central reason why patient care is not the central focus of our health care system.

What it takes to 'crack the code' of health care costs is a willingness to look at the waste that drives American health care costs up and beyond international comparison. Health system waste occurs because we have a poor quality health care system (inappropriate care (including defensive medicine), patient injury, and an inability to provide timely, clinically appropriate services) which operates inefficiently (overhead is 5-10 times higher than international standards of performance). Together, these wasteful business practices cost us $1 trillion per year. Most of the money lost comes from tax payers. Surely we should expect our elected leaders to have the political courage to say no to wasteful health system business practices? But, they respond to corporate interests in the health system instead of protecting patients and carefully managing public funds. And thus, health system reform becomes messy.

Why not bring real health system reform to the ballot so real voters (who are both patients and tax payers) can do what elected officials refuse to do?

Join the Utah Healthcare Initiative and make real health system reform in the Beehive State happen.

Dr. Joe Jarvis