Jeffrey S. Flier, the dean of Harvard Medical School, takes on Washington’s approach to health reform, and no side is spared his disapproval:
Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.
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.
Those of you who think this debate is about reining in the insurance companies, think again:
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. (emphasis added)
He goes on to describe the changes that are already necessary in Massachusetts just three years after that state passed health legislation with many similarities to the bills which Congress is debating. There, a commission has concluded that within five years the state’s health-payment system must be overhauled. Flier notes that “the details of this massive change…are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.”
So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.
We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.
Is it too much to ask for any federal health reform to get at least a passing grade from a man like the Harvard Medical School dean? Note to Congress: Start over.