John McDonough’s A Healthy Blog over at Health Care for All just turned 2, and he has a self-interview to mark the milestone. He answered a series of questions posed by readers. Here’s the one I asked along with John’s answer:
Once the health care reform bill is fully in force, do you think health care inflation will accelerate or decelerate? (David Williams)
Unfortunately, this is the policy area where I have the least optimism. My sense is legislative and executive branch leaders are tasking the critically important policy area of health care cost control to the nascent Quality & Cost Council, and I donâ€™t think that body (in spite of great, dedicated folks on it) has the political juice to make a meaningful difference. I would love to be proved wrong.
Fixing health care costs will require determined, relentless and courageous commitment by the Governor, Speaker, and Senate President. (Thereâ€™s even reason to doubt this can really be done in a single state.) There is no way to make a difference without a major, ugly political fight. Someoneâ€™s ox must be gored (insurers, hospitals, drug and device maker companies, physicians, business, labor, or consumers â€“ take your pick of one, more, or all). Itâ€™s unavoidable unless we choose to avoid the issue.
Rising health costs is the global climate change of health care policy. Itâ€™s fundamentally wrecking our economy. A doc from Illinois who is working with IHI told me Friday if you subtract health spending, US GDP has been FLAT since 1980. Meanwhile, we have good reason to conclude that as much as half of US health spending is clinical and administrative waste. The glaciers of our economy are melting. And I canâ€™t think of a single US credible elected official â€“ state or federal â€“ who is talking about real solutions.
On the larger issue of costs, MA health reform is insignificant. Except this â€“ some say we should not have done MA health reform until we figured out costs. The only people Iâ€™ve heard say that, more than a few, all have good insurance coverage. Havenâ€™t heard any uninsured folks say this. To tell a half million uninsured MA residents they should wait for coverage until we figure out the solution to costs is flat out immoral.
I’m a shade more optimistic than John on this topic. I’m hopeful that if we can get to the point where (almost) everyone in the state is insured, there will be a stronger political will –supported by the grassroots– to address the cost issues. If the problem can be framed as “What do we have to do to sustain universal coverage?” then maybe we’ll have a shot. No question there will have to be Federal involvement, too.April 2, 2007