Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.
Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that’s not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost—and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.
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.~~~
Ultimately, our capacity to innovate and develop new therapies would suffer most of all.
Meanwhile, another Harvard alumni weighs in:
Joseph Stubbs, President of the American College of Physicians — the second largest doctors’ group in the country — confirms that “the supply of doctors just won’t be there” for the 30 million new patients Barack Obama wants to cover. Noting that the doctor shortage is “already a catastrophic crisis,” Stubbs said that underserved areas in the U.S. currently need almost 17,000 new primary care physicians even before Obama’s proposals are enacted.
In the meantime, according to Bloomberg News, a 2009 survey by Merritt Hawkins and Associates, a recruiting and research firm in Irving, Texas, found that “the average waiting time to see a family-medicine doctor in Boston … is 63 days, the most among the 15 cities” surveyed. By comparison, in Miami, it was only seven days.
The study noted that Boston’s longer wait was “driven in part by the health-care reform initiative” passed in 2006 in Massachusetts upon which the Obama program is modeled. Bloomberg reported that “as many as half of doctors in the state have closed their practices to new patients, forcing many of the newly insured to turn to emergency rooms for care.”
Alan Goroll, a professor at Harvard Medical School said that “the primary lesson of health-care reform in Massachusetts is that you can’t increase the number of insured unless you have a strong primary-care base in place to receive them. Without that foundation … Massachusetts has ended up with higher costs and people going to emergency rooms when they can’t find a doctor.”
And, a study by the Centers for Medicare and Medicaid, part of the federal government’s Health and Human Services Department, found that expanding insurance coverage to an estimated 32 million people who now lack it would create a demand for medical services that “could be difficult to meet initially … and could lead to price-increases, cost-shifting, and-or changes in providers’ willingness to treat patients with low-reimbursement health coverage.”
Indeed, the report found that the Medicare cuts contained in the House-passed bill are likely to “prove so costly to hospitals and nursing homes that they could stop taking Medicare altogether.”