onservatives are often tagged as “anti-intellectual,” while liberals tend to argue that we should listen closely to what the intelligentsia says about how we should order society. The late William F. Buckley famously said that he’d rather trust the government to the first 400 people in the Boston phone book than to Harvard’s faculty.
For the most part (as a former miserable Harvard grad student), I’d heartily agree. Yet this was a refreshing oped from Jeffrey S. Filer, the Dean of Harvard’s Medical School. It seems that even the government-loving liberals at Harvard recognize that the promises being made by Team Obama and Pelosi about controlling health care costs while expanding insurance coverage by millions without sacrificing quality of care is absurd. Here is how this Harvard Dean puts it:
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.
In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care’s dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.
Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.
In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system-now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all.
And the Dean reminds us that we already have a case study of how this type of health reform works in Massachusetts–and it’s pretty much a disaster:
There are important lessons to be learned from recent experience with reform in Massachusetts. Here, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but-despite initial predictions-increased total spending.
A “Special Commission on the Health Care Payment System” recently declared that the Massachusetts health-care payment system must be changed over the next five years, most likely to one involving “capitated” payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change-necessitated by skyrocketing costs and a desire to improve quality-are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.
Yet it’s entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire. Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law.
So, yes, this time, let’s bow down to the superior intellects at Harvard and stop the push for ill-conceived health care reform legislation.