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A Bad Call on Employer-Sponsored Health Plans

by Fred Fortin

In an odd mixture of practical recommendations and wishful thinking, the Committee for Economic Development (CED)has issued its plan for health care reform. Of course first we have to suffer through the typical litany of exaggerations when it comes to the failures in US health care such as “No one has an incentive to seek, or provide, quality, cost-effective health care . . .” or “. . . there is no meaningful competition in our employer-based health insurance system” or “There is little or no incentive to utilize cost saving technology. . .” and “. . . employers can generally offer only one plan.”

Really? But, we really shouldn’t whine since we’re used to these opening rhetorical salvos by now. Seems everyone has the same script.

The intent of the plan is to move US health care beyond the employer-based health insurance system through the development of regional “exchanges” that would provide a single point of entry for individuals to choose among competing private health plans. There is also the strong suggestion of national regulation of health care insurance that accompanies this recommendation about which, in truth, I have railed against before.

But just as important, I’ve argued that taking employers out of the loop – as much as they, and many health activists, would love it – removes a critical player, who, for better or worse, provides some serious local and national weight in the balancing of health care demands against economic realities. Take them out and what do we have left — the medical-industrial-complex battling with government bureaucracies? Who is going to be the grown up there?

In contrast to those recommendations, the CED calls for a national “Health Fed” (to set performance standards, collect data, estimate future costs etc) as well as an “Institute for Medical Outcomes and Technology Assessments” – all reasonable and worthwhile suggestions. Both could be done now and with good effect.

As far as the wishful thinking goes, it is spread quite thick in this proposal. One example will suffice. I quote from the report,

“With health plans competing to attract cost-conscious consumers, we can expect our health-care system to change for the better. Health providers would be accountable for quality and cost. To remain affordable while maintaining quality for their customers, providers would need to adapt to new challenges and opportunities. They would move away from fee-for-service episodic treatment of symptoms to emphasizing primary care, health promotion, disease prevention, early detection and treatment, chronic disease management, and cost-reducing innovation and process improvement – including efficient use of technology, such as electronic medical records, knowledge management, and computerized caregiver support tools; better use of physicians’ time, in part through team practice with non-M.D. professionals; matching resources to the needs of the populations served; and regional concentration of complex care, to achieve expertise and economies of scale. To control costs, providers would need to avoid conflicts of interest, and use the best possible evaluation of the efficacy of treatments and therapies.”

No one disagrees with the wish list. The disagreement comes in with the oversimplification of what it will take to get us there.

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