How Congress Can Blow It

Health reform is at risk, and always will be. This, from Christopher Rowland in The Boston Globe, illustrates how:

A $3 million campaign by doctors, scanner operators, manufacturers, and groups devoted to women’s health helped persuade lawmakers to overrule Medicare administrators this year and restore much of the reimbursement for osteoporosis tests. In a little-noticed provision buried deep in the sweeping new health care bill, Congress decreed that Medicare shall pay $97 for each test, instead of $50.

It was a stark instance of a narrowly tailored, special-interest political victory in a law trumpeted by President Obama and Democrats as putting America on a path to a more rational health care system, where decisions are made on medical evidence and patient outcomes. …

Some also wonder if it is a harbinger of more political fights over health pricing, as the medical industry tries to resist government efforts to link Medicare and Medicaid payments to things like medical evidence and patient outcomes.

Even if a medical procedure deserves higher Medicare reimbursement, that should not be established by a special provision in law tailored for that procedure. There ought to be–and in fact there is–a systematic way to set Medicare prices. If that system proves flawed then the system should be adjusted.

I’m not a big fan of item-by-item administrative pricing, in general. I’d rather see organizations bidding for bundled payments. But if we are to have administrative pricing, or some of it, I don’t want Congress to be tinkering with it at the atomic level. That leaves far too much room for special interest rent seeking and waste. There outta be a law.

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