Monday, February 13, 2012

Health Care Is Not A New Car Or A New Coat.


It’s a service that everyone will utilize to varying degrees over the course of a lifetime, and its quality, accessibility and cost is a powerful determinant in the overall success of any society, including ours. 

Here is where we differ fundamentally.  I am not willing to accept the usual dislocations that a free market in health care would produce. Some would do very well (certain hospitals, drug and device makers, and physicians). Others would be crushed. And such a system would do little to improve overall health, which isn’t very good right now anyway. I believe allowing the current system to continue would damage us, irreparably. Leave aside the moral issue of allowing a fifth of the population to go without health care, or worse, to get care that is even more inadequate and expensive 

I remain mystified that our current system, which doesn’t work very well by any rational measure, remains so appealing to “conservatives.”  The fact that there is no extant or historical example of it being done this way anywhere else doesn’t seem to matter. All those Tea Party retirees screaming for their Medicare, a single payer system that allows them to gorge themselves at the expense of the young while bankrupting the country doesn’t seem to bother anyone on the right (or the left). Why? Because they can count votes. The message is clear. I got mine. The rest of you are on your own.

Your criticism that the Affordable Care Act reinforces inflexibility is at best an incomplete assessment of what if actually does. The formation of ACOs, or accountable care organizations, the innovation at the heart of the legislation, allows for great flexibility in how care is provided. Within a few broad rules (number of covered lives and range of services provided), an ACO is allowed to organize itself anyway it wants. Perhaps the heart of opposition to the ACA stems from the fact it limits private insurers profit margins to 15 cents on the dollar

And the Act has multiple provisions to monitor quality and effectiveness, which are irreplaceable functions of government (that dirty word). What the act does not do sufficiently is control cost. Romneycare, the blueprint for the ACA  suffers from the same deficiency, but the Massachusetts legislature is beginning to address that issue in innovative ways that are likely to be emulated in the way that Romneycare provided the blueprint for the ACA   


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