Is “ObamaCare” All About Rationing?
I learned a lot about conservative economics and the role of government from Marty Feldstein during my three terms in the U.S. Senate, particularly around health policy. I also know he's no expert on health care delivery and the variety of health systems which make up this interesting country of ours. His recent Wall Street Journal article, “ObamaCare Is All About Rationing,” is the second opinion he's offered on Democratic health reform policies which illustrate why he needs to better understand medical economics.
He raises two policy issues in this opinion. The first is the over-consumption of health care services in this country and the role that health insurance and insurance tax treatment play in encouraging it. With that, I have little or no disagreement. With his tax reform solutions, I'd only suggest that tax and income equity might dictate something other than a regressive HSA as a publically financed cure.
The second issue is the over-utilization of health care services encouraged by medical professional practice patterns, the encouragement of over-utilization by fee-for-service payment policy, and the discouragement of conservative, results-oriented practice by the same fee-for-service policy. Obama and Democrats in Congress, with help from blue dog Dems in states like Minnesota, want to use comparative performance information to enhance consumer choice. Feldstein chooses to call any effort at comparing physician performance “rationing.”
He is dead wrong. Just as he was in an earlier Op-Ed declaring the difference in practice results and costs between New York and Minnesota is due to genetics. He can check with people who live in Hawaii, northern California, the Pacific Northwest and the upper Midwest and New England to see whether they think they are being denied access to needed health care services. Try Group Health of Puget Sound or HealthPartners in Minnesota. Anyone in North Dakota, with the lowest PMPM premiums in the country. Grand Junction, CA; Ogden, UT; LaCrosse, WI; Hershey, PA, and a long list of others.
Physician leadership makes all the difference in the world. So do states with a commitment to expanding coverage to as many citizens as possible and to enhancing the use of quality and performance data to better inform consumer choice of health plans and providers.