Last week, Harvard Medical School Dean Jeffrey Flier commented on the debate over health care reform. His article begins:
As the dean of Harvard Medical School I am frequently asked to comment on the health-reform debate. I’d give it a failing grade.
Instead of forthrightly dealing with the fundamental problems, discussion is dominated by rival factions struggling to enact or defeat President Barack Obama’s agenda. The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health—not politics—have been left in the lurch. And as controversy heads toward a conclusion in Washington, it appears that the people who favor the legislation are engaged in collective denial.
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.
Read the whole thing.
af says:
I read the whole thing and am confused. Dean Flier cites the Massachusetts experience as relevant. Apparently the Massachusetts reforms, which are similar to the national reforms, have already led to a push toward “massive change” in cost control. How this squares with Dean Flier’s statement that the current reform is not going to move us in the direct of cost control is unclear. But his problem with Massachusetts seems to based on concerns about about how cost control “would impact physician practices and compensation, hospital organizations and their capacity to invest.” In other words, it seems, he’s concerned that controlling medical costs would lead to lower compensation for providers of medical services. Which as the Dean of Harvard Medical School he would be concerned about. But there seems to be a contradiction between his calls for cost control in the abstract and his opposition to all actually existing cost-control measures.
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November 24, 2009, 9:22 amseth says:
cost controls which would fall primarily on medical providers do little to account for the factors that drive costs up in the first place and could likely cause potential physicians to choose another field. (but hey, doctor’s are rich and if we can pass ill conceived health reform on their backs, why not?) any thoughts on how a shortage of health care providers might affect costs?
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November 24, 2009, 9:45 amCousin Vinny says:
“Read the whole thing.”
This somewhat abrupt command comes across as annoying and rude (to me, at least). The wordier version is, for once, probably better:
“Dean Flier’s article is well worth reading in its entirety.”
“I recommend that people interested in the health care debate read all of Dean Flier’s article.”
etc.
Now,
Do what I say.
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November 24, 2009, 10:01 amseth says:
so as i reread that, it seemed slightly more antagonistic than i meant it to be (and pretty much in line w/ the rhetoric flier is criticizing).
if i were trying to be constructive, i suppose i’d ask whether people actually believe that the point of these reforms is to curb costs.
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November 24, 2009, 10:07 amaf says:
“i suppose i’d ask whether people actually believe that the point of these reforms is to curb costs.”
The point of the reforms is to expand access to health care. The bill’s proponents understand that do that in a sustainable and responsible way, it is necessary to curb costs. The bill includes some cost-cutting measures, probably as many as are politically feasible, but they are not radical.
I would like to turn the question around and ask whether anyone believes that opponents of the bill actually want to curb costs. It seems to me that most, including Flier, are deeply contradictory on this point. They oppose the bill for not making unpopular cost cuts, while at the same time gravely warning that it might lead to unpopular cost cuts.
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November 24, 2009, 10:20 amHans Bader says:
The Harvard Dean criticized the health care bills backed by Obama — not just the healthcare debate.
He wrote in the Wall Street Journal that along “with dozens of health-care leaders and economists,” he had concluded that the bill “will markedly accelerate national health-care spending,” would harm care “by overregulating the health-care system in the service of special interests such as insurance companies,” and would reduce “our capacity to innovate and develop new therapies” that save lives.
Other experts agree with the Dean that ObamaCare will cost lives by reducing medical innovation.
“Would ObamaCare Kill Medical Innovation?” That’s the question posed by healthcare expert Michael Cannon. His answer is yes: “President Obama’s health plan would likely reduce such innovation, to the detriment of the entire world.”
That is just the tip of the iceberg in what ObamaCare will cost our society. It will also raise taxes, deficits, and medical costs.
The Senate recently voted 60-to-39, along party lines, to press towards passage of a massive health care bill, blocking a Republican filibuster.
Afterward, however, the bill drew criticism even from moderate Democrats who usually support the Obama administration, which backs the bill. Veteran Washington Post editorialist David Broder called the bill a “budget buster in the making,” saying it will violate President Obama’s “pledge that health insurance reform will not add to our federal budget deficit over the next decade.” He pleaded with the Obama administration and Congress not to “pass along unfunded programs to our children and grandchildren.”
In the Examiner, a Democrat who backed Obama in 2008 criticized the administration for backing a health care bill that violates Obama’s campaign promises by raising taxes on the middle class, citing the bill’s many tax increases, such as its tax on uninsured people and taxes on cosmetic surgery and other medical procedures.
Earlier, Tennessee Governor Phil Bredesen (D) criticized ObamaCare for driving up state spending and budget deficits, calling it “the mother of all unfunded mandates.”
Washington Post columnist Robert Samuelson today called ObamaCare a generational rip-off. Earlier, he noted that the health care bill is “hypocritical” and “dishonest” and aggravates the worst features of the “status quo.”
In the Senate, all Democrats voted for the bill. But many received payoffs for doing so. And there really are no “moderate” Democrats left in the Senate: most of its so-called “moderate” Democrats are not moderate or conservative on anything except on a handful of social issues needed to survive in a “red state,” like gun control. No Senate Democrat today deviates from the liberal party line as often as the moderate Democrats who once served in the Senate, like Senators Alan Dixon of Illinois and J. James Exon of Nebraska.
Senate Majority Leader Harry Reid (D-Nev.) lined up the 60 votes through payoffs to wavering Senators and powerful unions (some mismanaged unions will receive a taxpayer bailout of their health plans, to the tune of up to $10 billion).
The health care “reform” bill backed by President Obama “would reduce senior care,” increase “medical costs,” and “could jeopardize access to care for millions,” report health care experts at the federal Centers for Medicare and Medicaid Services. The House recently passed a similar bill by the razor-thin margin of 220 to 215.
The bill will raise taxes on the middle class. It will increase taxes on individuals, employers, and hospitals, impose new taxes on medical devices and cosmetic surgery, and levy a 40% tax on health-care plans above $8,500. It will increase the deficit, drive up state government spending, and cost taxpayers at least twice as much as predicted. It is one of the most expensive bills of all time.
It contains special-interest pork, such as payoffs for trial lawyers, and racial preferences that drew criticism from the U.S. Commission on Civil Rights. The bill restricts national competition in health insurance, which is permitted in countries with cheaper health care.
ObamaCare spends money on frills like “cultural competency,” while cutting spending on crucial things like anesthesia.
“ObamaCare is all about rationing,” and tax increases, says one of Obama’s own economic advisers, Martin Feldstein.
Fact-checkers say Obama is lying about health care. Obama often contradicts himself. In the very same speech, Obama claimed that Medicare is “unsustainable” and “running out of money,” then contradicted himself by claiming that “Medicare is a government program that works really well,” making it a model for national health care.
CNN noted that Obama’s plan would take away “5 freedoms,” contradicting Obama’s claim that the bill will leave you free to choose your doctor and keep your healthcare plan without government interference.
The bill does nothing to curb massive waste and fraud in existing government health care systems like Medicare and Medicaid, even though it proposes to make massive cuts in Medicare (cuts so painful that most of them will never happen: year after year, Congress waives “the annual cut in fees paid by Medicare to physicians” mandated by an earlier law. The cuts were added to the bill only to reduce its apparent cost. As economist and former Congressional Budget Office director Douglas Holtz-Eakin notes in The Wall Street Journal, the promised cuts to pay for ObamaCare will not happen: “Senate Democrats chose to ignore this reality and rely on the promise of a cut to make their bill add up. Taking note of this fact . . . destroys any pretense of budget balance.”)
Backers of ObamaCare have refused to cut medical costs through malpractice reform, with Senate Majority Leader Harry Reid saying that such reforms would save “only” $54 billion. The Pacific Research Institute estimates that just one type of cost that could be reduced through malpractice-lawsuit reform — defensive medicine — costs around $200 billion annually (which is almost as much as France spends annually on health care for all of its citizens; like most countries, France has no punitive damages, and fewer lawsuits against doctors).
One reform opposed by the Democrats — setting up specialized health tribunals to hear malpractice cases — would be particularly helpful. Replacing uninformed juries with specialized health courts would provide more consistent rulings from case to case, eliminate meritless cases, reduce defensive medicine, and more speedily compensate injured people. Such tribunals already exist in countries like “Sweden, Denmark, Finland, Iceland and New Zealand.”
Martin Feldstein, one of Obama’s own advisors, has said that Obama’s health-care plan would explode the federal budget deficit and lead to “crippling deficits,” as well as “higher taxes, debt payments, and interest rates” that would cut America’s standard of living. Feldstein also noted that Obama’s health-care plan would harm people with insurance, and predicted that it would lead to massive tax increases. Other analysts have predicted that it will drive up medical costs and inflation.
Obama has relied on $2 trillion in imaginary savings to pay for healthcare “reform.”
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November 24, 2009, 10:26 amaf says:
Spam much, Hans?
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November 24, 2009, 11:18 amseth says:
i hate to seem like a conspiracy minded troll,
but i’m starting to wonder if the point isn’t to avoid cutting costs so as to ensure that the public option is the only option (thereby drastically expanding ‘access’).
while i’m not really familiar enough with the bill to consider myself diametrically opposed, i would place myself in the leagues of those who are satisfied with their health insurance, but don’t want to see (can’t afford) premiums (which) continue to rise 10–25% per year.
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November 24, 2009, 11:45 amR. Richard Schweitzer says:
It does take some effort, but even rapid scanning of the proposed legislation makes it clear, as Dr. Flier indicates, the entire project is one to redistribute costs and benefits via political fiat.
Despite public objections this will continue. It offers a majority party, taking control of redistribution, the prospect of becoming a ruling party.
However, because of the attempt to seize authority to command the purchase of any good or service that Congress may design, select or specify, the public objection will be expressed in forms that may go beyond Constitutional challenge, which will certainly occur.
Without confirmation of that authority, the control of this redistribution can not succeed.
What will come of the “front end” revenue measures of the first 4 or 5 years before “benefits” are to begin may become a very large political problem in itself.
R Richard Schweitzer
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November 24, 2009, 11:45 amYankev says:
Instead of a command, you may prefer to think of it as a subliminal suggestion, along the lines of “These are not the droids you want.”
Remember, Psycorp is your friend.
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November 24, 2009, 12:11 pm24AheadDotCom says:
After the article came out last week, I sent him an email with my solution to raising the level of debate in the U.S., one that I’ve discussed here and elsewhere many times over the past 2.75 years. I never heard back from him and I’ve gotten almost zero help with my plan from anyone else. Speaking generally and not necessarily of him, I get the impression that most people don’t really want a real debate about issues like this.
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November 24, 2009, 1:16 pmAllan Walstad says:
Well, one way to expand access is to eliminate barriers to lowering cost. So, for example, Congress could actually invoke a Constitutional power it does have (rather than flout its Constitutional limits) by abolishing state government infringements on buying health insurance across state lines, thereby opening up the market to more competition. It could extend the tax benefits of employer-offered health insurance to all health insurance (or just eliminate the special tax status of health insurance altogether), again opening up the market. It could eliminate the many government mandates as to what things must be covered and let people choose for themselves. It could rein in astronomical malpractice claims.
Of course, another way to “expand access” is simply to force people to buy insurance and punish them otherwise, thereby substituting the pols’ choices for the choices of individuals as to how to allocate their own resources. That seems to be a popular idea among the pols these days.
And another way to “expand access” is to rob or otherwise coerce some people to pay others’ expenses. A common car thief “expands access” to transportation in much the same way. This too appears popular among the pols and others who speak of “expanding access.”
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November 24, 2009, 1:26 pmJRL says:
I thought he was just bragging, as in “[I R]ead the whole thing. Ha! Take that!”
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November 24, 2009, 1:53 pmDan Weber says:
The current bill sucks, but the Republicans’ attempt to pretend that, just now, they care about exploding budgets is a load of crap.
If you want to know what Republicans would pass if they were in power, see Medicare Part D. Like the current bill, it gave away a whole bunch of stuff, then put the question of how to pay for it into a can that got kicked a decade down the road.
Until you can find someone brave enough to tell the people “no, you cannot have all the care you (or your doctor) could possibly imagine,” we are going to dump massively huge amounts of money into health care to the detriment of other more efficient goals.
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November 24, 2009, 2:31 pmThe Volokh Conspiracy » Blog Archive » Dean Flier on Health Care … | Health Blog says:
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The Volokh Conspiracy » Blog Archive » Dean Flier on Health Care … | Health blog says:
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Mark Buehner says:
Err, of course, why wouldn’t they? That doesn’t mean they have a silver bullet solution, of course. Who’s got the moral highground, the side pretending their solution will work when to every appearance it will make things worse, or the side that is indicating it wont work and suggest modest reforms to move things in the right direction?
There is something to be said for tort reform, interstate insurance markets, and altering tax incentives that tend to drive up consumption.
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November 24, 2009, 5:40 pmMark Buehner says:
I ask this question a lot, but will somebody in favor of this bill explain to me how creating a relatively small penalty for not having insurance while forcing insurers to cover anybody regardless of preexisting conditions isn’t a recipe for MORE free riding? Wouldn’t a healthy individual be an idiot not to drop their coverage, pay the thousand dollar fine, and then buy their healthcare if and when they get sick? And then drop it when they get well?
I have yet to have anyone even attempt to explain why this won’t happen and why it won’t drive premiums up.
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November 24, 2009, 5:43 pmeyesay says:
Jonathan H. Adler quoted Harvard Medical School Dean Jeffrey Flier saying, “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.”
As President Obama has said, the best way to control costs would be to adopt a single-payer health care payment system. Unfortunately, there aren’t the votes in Congress to pass such a bill right now, thereby consigning our nation to second-rate reform that will be better than the status quo in controlling costs, in covering the population, and in protecting the people from shenanigans (like insurance companies refusing to pay for cancer treatment because of unreported teenage acne).
Thank you, President Obama and House and Senate Democrats, for finally delivering what the great majority of Americans have been asking for — health care reform. It is regrettable that the politics aren’t right for a single payer plan that would have even better cost containment, but we’re grateful for these reforms, and we are confident that, whatever new problems result, they will be fixable and they will be benign in comparison to the status quo, which isn’t working well for anybody except the insurance company and those lucky enough to have gold-plated policies.
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November 24, 2009, 6:03 pmMark Buehner says:
I see– we can’t give you a reform that will work, so we should be thanked for giving you a reform that won’t work, because at least its a change.
Makes perfect sense...
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November 24, 2009, 6:08 pmYankev says:
f Actually, you should thank us even more for giving you a reform that not only won’t work, but that exacerbates nearly every problem with the current system, and for calling you names whenever you try to point out the mistakes.
And if calling you names does not work, we can always send out more SEIU thugs to beat you into a wheel chair, as we pontificate about how violent you would be if we gave you half the chance.
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November 24, 2009, 6:42 pmrpt says:
The “Corporate Enterprise Institute” in action.
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November 24, 2009, 11:51 pmThe Volokh Conspiracy » Blog Archive » Dean Flier on Health Care … « Blogging says:
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