State

Getting rid of the health care rhinos in your field

Forget the wonkery. Let's get primeval. Rising health care costs are a stampede of big ugly rhinos trampling your crops, stomping on your children's play areas and spoiling your hunting grounds.

President Barack Obama wasn't exaggerating when he said this cost onslaught is unsustainable. The rhinos have been roaming unchecked for a generation. They are closing off your future. As the White House folks say, health care premiums have doubled over the last decade. The government is saddled with $36 trillion in unfunded liabilities.

So your only question should be: Where do you find a tool or weapon big enough to stop the rhino stampedes? You look on Capitol Hill and see a bunch of popguns.

In other words, we're going to eliminate the biggest, hairiest, most entrenched problem in the country without fundamentally changing the system and without asking for sacrifice from anybody.

Good luck.

Then you talk to the health care experts promoting the bills and they are very honest: We don't know exactly how to slow health care inflation. But we think we have some good ideas.

And, indeed, some of the ideas do sound good: more information technology, comparative effectiveness research, conducting experiments to bundle hospital payments so they are based on outcomes. Some of the providers that do things right, like the Mayo Clinic, really are getting results.

But some of these ideas have been watered down in the legislation. You know there is a big difference between finding islands of excellence and creating a national system based on them.

Besides, you've got a bunch of big, evil rhinos stomping around! You want some big, heavy hammers to clock those suckers in the head.

Now that the first wave of legislation is bogging down, you want to take the seeds of cost control and you want to do more. You want to eliminate or cap the tax exemption on employee health benefits. This is a big way to crush one of the core drivers of health care inflation.

You want to loosen federal regulations so that states have more room to experiment -- not tighten them, as the current legislation does, so that states have less. You want reforms throughout the system that will cut down on first-dollar reimbursement in exchange for catastrophic protection. You want to tie Medicare subsidies to income. You want to look at anything that will move us away from fee-for-service, the core perversion in the system.

The legislators who drew up the first bills want to change provider incentives. But big cost savings can also come if consumers have choices and incentives to hunt for cheaper coverage. The Wyden-Bennett bill gives people a chance to choose the best option, instead of imprisoning people in existing coverage, as the current legislation does. The Medicare Part D reform has produced impressive reductions by allowing consumers to pocket prescription drug savings. Other proposals would give people tax credits and allow them to go to any trusted community group that wanted to compete to offer coverage.

Not everything is compatible with everything else. But the point is that you have rhinos at the door! You'll try anything that works.

Obama is right. Things will be bad if we don't tackle the problem this year. Things will be worse if we add to the costs without beating the rhinos.

THE NEW YORK TIMES

  Comments