Thursday, April 18, 2013

With Bipartisanship Like This, Health Care Doesn't Need Enemies

When you hear about an organization that calls itself the "Bipartisan Policy Center", what's the first question that comes to mind? If I spot you this essay, might it be, "I wonder how they bankroll themselves, whose policy positions they're pushing under the guise of 'bipartisanship'"? No real surprise - when you are willing to offer a big enough paycheck, you can get people from both sides of the aisle to sign on to your clients' positions.

So, then, what's the basic premise of this special interest front group?
What we learned is that, until better care is prioritized over more care, our nation will continue to face a problem with health-care costs. The good news is that, through thoughtful policy, health-care practitioners can be encouraged through rewards to focus far more on what is best for their patients and less on the number of tests and procedures they can order. The even better news is that such a health-care vision can not only produce better care but also cost less.
So... Bill Frist has given up his habit of diagnosing medical conditions from the Senate floor, then insisting that their lives be prolonged indefinitely no matter what the financial cost to the country or emotional cost to their family? Was it the "bipartisanship" that brought him around, or the paycheck, because... You'll please excuse my skepticism that Tom Daschle and Bill Frist couldn't see eye-to-eye on what was good for the nation when they were being paid by the taxpayer to do so, but fell into a warm mutual embrace of their employer's policy position the second they entered the private sector.

Well, they claim that we can pay less and get better healthcare. So how do they, the admitted beneficiaries of the best health care our nation has to offer, far better than the average American can presently hope to obtain, propose to give us this "higher quality and greater efficiency" at a lower cost?
To address these, we seek to promote coordinated and accountable systems of health-care delivery and payment, building on what has proved successful in the private and public sectors. Organized systems of care emphasize the value of care delivered over the volume of care. These systems are often better able to meet patients’ needs and desires and are able to effectively reimburse providers and practitioners for delivering high-quality care.
That sounds like... obfuscation. It would be helpful if they would start by identifying the systems that have "proved successful in the private and public sectors", but... I know, far too much to ask. Besides, if they were to approach that issue honestly they would have to praise the efficiency and popularity of Medicare and the single-payer V.A. system, as well as the fact that every other industrialized nation has managed to offer an overall quality of care comparable to that of the U.S. at a considerably lower cost.

So, if they cannot identify even one of the "coordinated and accountable systems of health-care delivery and payment" they used as their model, perhaps they can help us by giving us examples of that coordination and accountability. You know, of the sort of measures that will result in better care for less money.
  • They propose to "Preserve the promise of traditional Medicare while adding more choices and protections for beneficiaries, including accountable systems of care and a stronger, more competitive Medicare Advantage program." So "keep Medicare but with added buzzwords" - and then magically create a "stronger, more competitive Medicare Advantage program"... does that mean, one that won't require massive subsidies to attract even a single consumer to migrate from standard Medicare? Just asking.

  • They propose to "Strengthen and modernize the traditional Medicare benefit, including adding a catastrophic cap, rationalizing cost-sharing and premiums and expanding access to assistance programs for those with low incomes" - in case you're not paying attention, what they're saying here is that they want to cost-shift from the Medicare program to its beneficiaries. So... their two leading ideas have nothing to do with improved systems or providing better care. Should we hold our breath and expect things to get better?

  • They want to "Reform the tax treatment of health insurance to limit the taxfavored [sic] treatment of overly expensive insurance products" - In other words, if you have really great coverage (like the kind they, personally enjoy) they want to increase the tax burden on your employer so that your employer will offer you lesser coverage. Once again the entire focus is on shifting the cost of care from insurance to the consumer, and has absolutely nothing to do with improving care or efficiency.

  • They propose to "Empower patients by promoting transparency that is meaningful to consumers, families and businesses, and streamline quality reporting" - which, if they have actually studied the issue, they know translates into meaningless twaddle. But heck, it sounds like it came right out of a mission statement generator, so odds are you never thought it was anything but meaningless twaddle. The most charitable reading is that they propose to give consumers more information so that they can make their own decisions about their healthcare instead of deferring to their doctors. Oh, you thought you were going to hear about things that work, things that improve care and lower costs, rather than the usual tired nonsense about how consumers can learn to manage the intricacies of their own medical care? Well, guess again!

  • They're going to "Advance the nation’s understanding of potential cost savings from prevention programs, through support for research and innovation on effective strategies to address costly chronic conditions" - because, you know, telling people, "If you don't smoke, lose weight, eat better, and exercise more, you'll be healthier", has been such a successful strategy to date. Because so many people have yet to hear that sort of hectoring.

  • Back to twaddle, "Offer incentives to states to promote policies that will support a more organized, value-driven health-care delivery and payment system, such as supporting medical liability reform and strengthening their primary-care workforce." In the real world, "medical liability reform" - that is to say, denying victims of malpractice effective redress through the courts" - has not resulted in cost savings. But clearly it's something that their employer's clients want, so there it is! And what does "strengthening the[] primary-care workforce" mean? Clearly it doesn't mean "hiring more primary care physicians", as so far this proposal is about anything but encouraging people to see their doctors when they're sick.

They pat themselves on the back,
All of these policies are designed to improve the quality and value of our nation’s health care. That is where every health-reform effort should start.
Sure, if we pretend that "improve the quality and value of our nation’s health care" is synonymous with "improve the bottom line of the industry groups that fund our organization". Given that none of the proposals as stated has any realistic chance of either improving the quality of care or improving the efficiency of the provision of care, but can be guaranteed to raise both cost and risk for the consumer, it's difficult for me to believe that they're fooling anybody with this other than the guy on the Washington Post's editorial board who approved the essay. I joke - the editorial board and its members push this sort of editorial with some regularity, knowing full well that they're at best pushing a half-truth and at worst pushing something that's good for the bottom line of the insurance, pharmaceutical or hospital industry even if harmful to consumers.
By presenting this report to federal, state and private-sector leaders, we hope to promote a collaborative dialogue and a shared understanding of strategies to put our nation’s health system, as well as its economic outlook, on a sounder, healthier and more sustainable path.
No, really, they don't. All four of the authors had the opportunity to do what was right for the nation when they held elected office, or when they worked in the public sector. Their unified front comes not from a realization of how obtuse and destructive they were when they couldn't agree, but from the fact that they won't keep their jobs if they don't push their employer's agenda. How about a little bit of honesty?


  1. What an odd organization. The appear to take money from other organizations (and probably industry) in order to create "bipartisan" proposals, and then they use a subsidiary to lobby Congress to pass their proposals. It's a nice layer of insulation between Congress and the special interests, branded as "bipartisanship", with a lot of happy, retired politicians collecting fat paychecks as part of the process.

  2. Frist is standing up for the business interests that made his family filthy rich. Rivlin seems to have a price tag on her forehead. Gephart is going to work for his clients at his consulting company, and what does one even have to say about Pete Dominici. Based on the information in Guidestar, Domenici's getting well over $300,000 per year from the "Bipartisan Policy Center" as a "consultant". Nice work if you can get it.


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