A good friend of mine sent me an op-ed from the Washington Post the other day that talked about the 5 myths of health care reform.  It was written by Shannon Brownlee and Ezekiel Emanuel.  I’ve written about both of them before (5/14/08 & 7/28/08).  Shannon Brownlee is a Visiting Scholar at the NIH’s Clinical Center, and Emanuel is the Chair of the Center’s Bioethics Department.  Ezekiel also happens to incoming White House Chief of Staff Rahm Emanuel’s brother.  Hmmm…

Anyway, I really like most of what they have to say - which will probably come as a surprise to them - and maybe to some of my colleagues as well.  Their five myths are, in no particular order…

1) America has the best healthcare in the world.

2) Somebody else is paying for your health insurance.

3) We would save a lot if we could cut the administrative waste of private insurance.

4) Health care reform is going to cost a bundle.

5) Americans aren’t ready for an overhaul of the health care system.

Let’s discuss.  On #1 - let’s face it, this one’s been beaten down for years, in study after study after study.  We certainly spend the most, but I’d be really hard pressed to find any study that indicates that spending the most money translates into high performance.  I don’t think we’re as bad as some would suggest - because we’re playing a much more complicated hand demographically than most countries, and frankly, many of the health status measures people rely on have a lot more to do with diet, exercise, and public health than the quality of the health care delivery system.

They’re dead right on #2 as well.  Private health insurance premiums are part of total compensation.  If the cost of health insurance is going up, it’s usually being paid for by incremental reductions in wage increases.  In addition, we all pay for Medicare, Medicaid, public health care, Veterans Health Care and other forms of publicly funded health care every time we pay our taxes.  Employers and governments don’t “fund” health care.  People do.

I’m obviously an “interested party” on #3 - and I’ve posted commentary on this issue before (10/6/08).  Believe me, if I thought just whacking the private plans into oblivion would solve the cost problem, I’d be hard-pressed to oppose it.  But I know the math is mostly about the cost of care, and it’s nice to hear someone else say it.

#4 is a bit more tricky, but not because I disagree with their fundamental assumption.  I just think saying you can reform the delivery system enough to save the money you need to save as you go about the process of enrolling the uninsured is the all-time, Hall of Fame, Numero Uno “easy to say, but hard to do” concept.  The system is expensive and inefficient - but its design is due - in many ways - to the interests, expectations and objectives of the people who participate in it.  In other words, it didn’t get this way by accident - it just looks like it did.

#5 is also kind of tricky.  People say, generally speaking, that the system needs an overhaul - right up until that overhaul affects the way they use the system now.  The challenge for the feds is translating that over-arching sense that something has to happen, which is shared by most voters, into specific plans and policies that reflect the change most people are anticipating.  This is also easy to say, but very hard to do.

But that said, this is a good list.  I look forward to more as this whole discussion rolls forward.

Posted by Charlie Baker in Health Care Costs