Healthcare

Smart people still miss the point on health care

You would think a person with the credentials such as below would be informed as to what he writes about. 

The fact is insurance companies don’t offer any care. The fact is the most generous health benefit plans are negotiated plans, especially among public unions. The fact is large employers offer (more correctly used to offer) such plans to attract and retain workers and would be quite happy to reduce the value of their plans as has been happening for years (shifting costs to workers of course). 

But the real fact missed is that these so-called generous plans among large employers and many unions are not insured at all, there is no “health insurance” as such and the insurance company that may be processing claims has no financial stake in what is spent on those claims. They are self-insured, self-funded by the employer or union and even when they are not, they are the product not of generosity, but of necessity in some manner.

And then we have “re­im­burse providers based on out­comes and qual­ity rather than in­puts and quan­tity.”  What makes us think we can pay doctors on that basis when we can’t even apply that criteria to teachers? 

The “do no harm” prin­ciple ex­tends be­yond the in­di­vid­ual mar­ket, where about 1 in 6 Amer­i­cans get their health care, ac­cord­ing to the Cen­sus Bu­reau. To cut cost growth and im­prove qual­ity, the ad­min­is­tra­tion will have to use other tools—many of them bi­par­ti­san—that have been cre­ated by Con­gress in re­cent years. These in­clude de­liv­ery-sys­tem re­forms in Medicare, which shift to pay­ment mod­els that re­im­burse providers based on out­comes and qual­ity rather than in­puts and quan­tity. 

A Re­pub­li­can Con­gress un­der the lead­er­ship of Speaker John Boehner al­ready ex­panded these re­forms af­ter they were orig­i­nally passed as part of the Af­ford­able Care Act. The “Cadil­lac tax,” which en­cour­ages in­sur­ance com­pa­nies not to of­fer overly ex­pen­sive care, should also stay. Nei­ther of these poli­cies re­quires con­gres­sional ac­tion. The ad­min­is­tra­tion sim­ply has to im­ple­ment the law as written.

Mr. Fur­man, a pro­fes­sor of prac­tice at the Har­vard Kennedy School, was chairman of the White House Coun­cil of Eco­nomic Ad­vis­ers, 2013-17.Wall Street Journal 7-24-17

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