• Beyond Washington

    The title to Andrew Sullivan’s post, “Tweaking healthcare: Look beyond Washington,” that highlights Aaron’s post from earlier today got me thinking. There’s another way in which we should be looking beyond Washington right now, and that pertains to the question “Was health reform worth it?”

    That’s a question many bloggers, journalists, commentators, and pundits have been asking and answering in recent days. Jon Cohn had a post on it today, one that links to related posts by many others. They’re all principally about the political consequences of health reform, though some mention the benefits of reform for the budget or insuring the uninsured. That is, in large part, they reflect a Washington focus.

    Let’s look beyond Washington. Doing so, we can recognize the most important benefit of health reform. It was, is, good for health. The principal way in which health reform is good for health is that it provides access to insurance for tens of millions of Americans. A secondary way is that it aims to increase the efficiency and quality of our health system through payment incentives and reduction of health care of low marginal value, in exchange for increasing provision of health care with high marginal value.

    But let’s just take insuring the uninsured. Many, many, many, many, many, many studies using the best statistical techniques find that insurance is good for health. Aaron and I have written about them numerous times, so I won’t do a literature review in this post. (Follow the “many” links provided above.)

    Given the importance of health reform for health, the interpretation of the question “Was health reform worth it?” in political terms, and only political terms, misses a lot. Even if health reform is responsible for a significant part of the mid-term’s outcome–and I don’t think it was–that it was worth it is not even a question in my mind. If one thinks that our health insurance system requires major reform, and I believe it does (who doesn’t?), then that’s the right thing to do. In fact, it was the right thing to do years ago.

    Was health reform worth it? Looking beyond Washington and focusing on health, the answer is clearly “yes.” Even if the politics don’t justify it, the health of Americans does.

    • AC360 grilled Michelle Bachmann yesterday to list just 3 things she would cut to help balance the budget – of course, she avoided answering that question. I’m sure most of the newly elected folks on that side of the aisle would “answer” the same way.

      I’ve also heard about subpoenas. To Quote Michelle (July-2010):

      When asked the question, “How do you feel about the chances for a little oversight and a little accountability now that the Republicans will have the subpoena power?” Michele Bachmann responded, “I think that all we should do is issue subpoenas and have one hearing after another. And expose all the nonsense that is going on. And it’s very important when we come back that we have constitutional conservative leadership because the American people’s patience is about this big.”

      I’ll tell you whose patience is “about this big,” mine. And, I trust, many others who would rather see discussions about things other than politics. Like facts.

      Seems like we need forum after forum to combat “hearing after hearing” until facts are what gets the headlines – not politics. Are there such forums (besides good blogs like this one!) that attempt to discuss facts, and not just politics? There must be. Doesn’t the medical industry care about improving health care for their constituents (please don’t take this personally!)?

      Actually, its hard to believe that hearings wouldn’t attract folks who ultimately tell the truth, and facts will begin to pile up. Now that we are beyond the election, the focus could shift to the factual…


    • “…reduction of health care of low marginal value, in exchange for increasing provision of health care with high marginal value.”

      I think I know what you mean by this line, but I don’t want to guess. What DO you mean, exactly?

      • @Brian – The uninsured get some coverage, preventative care has no copays, funding for comparative effectiveness research, incentives under ACOs, all of which is paid for by the excise tax on high-premium (rich benefit, in many cases) plans, scaling back of payments to Medicare Advantage (for low value benefits, according to my research), etc. … need I go on?

    • Well, the insurance industry is stepping up to defend the health reform, and according to the Cigna exec interviewed on Nightly Business Report, the insurance industry is working with both Democrats and Republicans on implementation. Keep in mind the law is based, thanks to the conservative Democrats, on State based exchanges, so two thirds of the governors and State legislatures putting the health reform in place are Republicans.

      Even if a Republican wins the Whitehouse in 2012, about all the new HHS head could do is grant all sorts of approvals to State programs that fail to meet the spirit of the reform – the insurers would have solid control of the political process by then to prevent reversing direction.

      In 2020, the programs might vary as much as Medicaid did in 1980, and still does to a large degree. But a half dozen States will have likely made significant strides in both expanding and improving coverage and in doing so, beginning to cut the cost increases.