A Review of Current Health Care Reform Strategy

Posted by Linda Gorman in Health Care on Mar 5th, 2009 | no responses

In view of the euphoria about public/private partnerships, and the massive public relations campaign that will undoubtedly accompany the Obama meeting celebrating the advantages of imitating government controlled health care reform failures, it’s time for a review of the health care reform strategy that the left has been pursuing since the late 1980s.

Dr. Jane Orient of the Association for American Physicians and Surgeons provided an important summary in her November 18, 1997 testimony before the Pennsylvania House of Representatives. Her full testimony is available on the AAPS web site. She uses quotes from a 1992 article in Health Affairs by Stephen Schroeder, then President of the Robert Wood Johnson Foundation, to illustrate her points. Citations are available on the AAPS link.

Because these comments predict what is happening now, they deserve repeating.

On public/private partnerships, Mr. Schroeder says that

The key to success in public/private partnerships is to induce the private sector to `play' on terms that are acceptable to the public sector

In other words, transparency and choice are just distractions. Medicaid, Medicare, or a health insurance Connector will control the health care you get based on government determined effectiveness research, and will tell you where and when you can be seen. Rules will be developed that drive private insurance and private physicians out of health care. This is happening in Massachusetts just as it happened in Tennessee under TennCare and in Kentucky under Kentucky Kare, other Robert Wood Johnson Foundation initiatives.

Putting the public sector in control is essential because private entities that don’t like Mr. Schroeder’s plans for them refuse to cooperate. To keep them in the system, it is necessary to force them to stay in by changing the rules and the societal values that make those rules. This explains why the left focuses on guaranteed issue for health insurers, pay-for-performance for private physicians, and Medicare and Medicaid for all.

The guaranteed issue laws that the Robert Wood Johnson Foundation championed in the early 1990s, and which destroyed the market for health insurance in Massachusetts, New York, and New Jersey, are simply a means to the end of forcing private actors to cooperate or be destroyed.

This, as Dr. Orient pointed out, requires a radical change in what society values. It also explains why all reform efforts are accompanied by massive public relations efforts.

One of the fruits of this effort is the switch in emphasis from health care as the provision of medical care to health care as “coverage.” Even though coverage does not guarantee care, national policy discussions are all about whether people have coverage. The fact that people with Medicaid, Medicare, or VA coverage often cannot access care is overlooked as are the massive shortages in care that Robert Wood Johnson designed third party coverage systems have created whenever they have been implemented.

As Mr. Schroeder put it

Fundamental change might be most constructively viewed as first requiring a change in societal values that then requires institutions to adapt to those changed values.

Mr. Schroeder also recognized that getting that kind of change would require reducing Americans’ distrust of their government by managing their perspectives. This explains the demonization of pharmaceutical companies, private insurers, and physicians that has characterized the health care debate over the last decade.

As Dr. Orient summarized Mr. Schroeder’s remarks:

`Getting the kind of broad-based political support needed to achieve universal access is going to be difficult,' Schroeder commented. America is very different from many other countries, he added; its citizens don't trust their government. `How to reconcile the need for universal coverage with a reluctance to have government in control of it is a real challenge for us as citizens'."

As far as one can tell, Mr. Schroeder never did consider the possibility that the irreconcilable differences between Americans and their government are well founded, or that these essential differences mean that health care and government should get a divorce.