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UI professor: Will the current health-care crisis continue?

BY SAMUEL LEVEY | DECEMBER 02, 2009 7:20 AM

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History has made it abundantly clear that our flawed health system will not change through voluntary private-sector initiatives. Many books, articles, and films have focused on the crisis in health care over the past several decades. In spite of massive national health expenditures and out-spending all other nations, the United States is not at or near the top in health status. Health-care, government, and business leaders have been paralyzed by equivocation and lack of will in formulating necessary strategies, structures, and legislation to redesign the ways in which health care is organized, delivered, and paid for.

There are too many well-heeled health-insurance executives, health-care managers, and professionals who are quite satisfied with the present system, broken as it is. The new president and the Democratic-controlled Congress should be congratulated for taking the initiative to attain a policy objective that has escaped the private sector for decades. Together, they are attempting to avoid re-enactment of the failed Clinton reform initiative in the early nineties. As Sen. Max Baucus, D-Mont., stated, “It’s time to get the job done. This is our opportunity to make history.”

Large numbers of Americans are hoping that Congress can fix the $2.5 trillion health muddle, soon to consume one-fifth of our Gross Domestic Product. But there are deep splits in the public’s perception of the direction of the proposed legislation, and opinion polls indicate that they are not persuaded that costs will be controlled. Facing large and growing U.S. deficits, conservative lobbyists and pundits argue that the health sector is too complex for policymakers to comprehend fully. They prefer slow incremental changes, supposedly to avoid predicted disastrous after-effects.

Some have even talked about future repeal of legislation that is passed.

The Senate bill, which is called the “Affordable Health Choices Act,” includes a public option and is being debated this week. The Senate Finance Committee bill did not include a public option because Baucus, who heads the committee, was not convinced that it could pass on the Senate floor. Both bills include many of the suggestions of policy gurus, economists, health-services researchers, and professional associations. Both include pilot programs and special studies aimed to eventually change how providers are paid.

As a large segment of the public has now realized, the big problem is how to “bend the cost curve,” so that health-care costs do not continue to escalate out of control. For the most part, the Senate has avoided grappling with robust mechanisms to reduce or control costs, and too few in that body have accepted the fact that cutting health-care expenditures is largely in the hands of our doctors. Large and unjustifiable differentials exist between physician specialists due primarily to the fee-for-service model of reimbursement. The White House is now under pressure to explain how much and where savings will be accrued through the proposed legislation.

Enactment of a health-care reform bill would be the largest addition to our social safety net since Lyndon Johnson’s presidency. If the necessary resolve to change the way that doctors, hospitals, and others in the health system are reimbursed does not prevail in the legislation that finally passes, we will provide better care to millions of uninsured and underinsured. But costs will continue to skyrocket, and the overall economy will be adversely affected.

Samuel Levey is a professor of health management and policy in the UI College of Public Health.


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