You didn’t watch the President’s Health Care Summit? Hey, I get paid to do these things so the rest of you can engage in more productive uses of your time.
Here’s what I learned: The people who are proposing to reform our health care system actually know very little about how our health care system works.
- Neither Democrats nor Republicans have any idea whatsoever about how to control the rate of growth of health care costs.
- Neither party has any idea how to fundamentally improve the quality of care.
- And although both parties would increase the number of people nominally insured, neither party truly understands the problem of access to care and neither has any realistic idea of how to achieve it.
Here is the lesson you can draw from all this: Under no circumstances do you want to give any of these guys power over your health care.
I will give the Democrats credit for coming up with lots of sob stories (every Democratic speaker had at least one heart-rending anecdote and most had two or three), even though almost none of them had anything to do with solving the problems of cost, quality or access to care. Since Republicans couldn’t produce even one sob story, here is a tear-jerker I offer them that I think tops all the Democratic ones:
“Tell Laura I Love Her”
On failure to control costs. Neither political party has a realistic plan to slow the rate of growth of health care costs. The only proposals that are being discussed are proposals that will shift the cost curve rather than change its slope. Democratic proposals to insure more people without expanding the supply side of the market (doctors, nurses, hospitals, etc.) and proposals to mandate the same premium for everyone (which will create perverse incentives for people to over-insure) will shift the cost curve up. Republican proposals for malpractice reform and proposals to allow the purchase of insurance across state lines will shift the cost curve down. However, none of these proposals will change the rate of growth of health care costs, which is the most serious problem facing this country and every other developed country in the world.
You cannot control costs unless someone (patient, employer, insurance company, government — someone, somewhere) is forced to choose between health care and other uses of money. And if patients are the ones making choices, providers will respond by competing based on price.
On the failure to improve quality. Did you know that somewhere between one in 200 and one in 500 patients admitted to a hospital dies there from some cause other than the medical condition that brought them to the hospital in the first place? The minimum standard regulatory agencies use in other markets is that risk should never fall below one in one million. Yet, it appears that none of yesterday’s Summit participants know this or have any earthly idea what to do about it.
The answer: We will not fundamentally improve quality unless providers compete on quality and no one competes on quality unless he also competes on price.
On the failure to improve access. Massachusetts has already done what ObamaCare promises to do: cut the uninsurance rate in half by enrolling people in Medicaid and subsidizing private insurance. But like ObamaCare, the Massachusetts health plan did nothing to liberate the supply side of the market. As a result, the waiting times to see a new doctor in Boston are twice as long as in any other U.S. city. And there are as many people going to emergency rooms for care in Massachusetts today as there were before the Massachusetts health plan was adopted.
Genuine improvement in access to care will require liberating the demand and supply sides of the market in ways that were never discussed at the Summit.