Thursday, January 8, 2009

Daschle on Health Care Reform: Will his proposals Change the Trajectory of Health Care Outlays?

I recently read Tom Daschle’s new book, “Critical: What We Can Do About the Health Care Crisis” (co-authored with Jeanne M. Lambrew and Scott S. Greenberger). This book has particular relevance since he will soon be the new czar of health care reform in the Obama administration. Arguing that it would be politically infeasible for the United States to move to a single payer, national health insurance scheme, Daschle and his colleagues argue for providing the option of an alternative health insurance scheme similar to that provided to Federal employees and the Congress. Such an approach would enhance competition with insurance provided by the private sector. They suggest that households unable to afford the purchase of federal insurance coverage might be made eligible for financial assistance through means-tested government subsidies. By extending the reach of the government beyond Medicaid, Medicare and the Veterans Administration, they believe that the combination of Federal insurance programs would also give the Federal government greater ability to influence how the private sector provides health care and its cost. (1)

The authors also call for the creation of a Federal Health Board (FHB) that would have direct authority over Federal health care programs, shaping the framework—as a “standard-setter”--for decisions on coverage and benefits, and introducing an evidence-based approach in considering the cost-effectiveness of drugs, devices, and medical procedures. They call for this agency to be accorded independence similar to that given to the Federal Reserve Board in the sphere of monetary policy (arguing that, as with monetary policy, Congress lacks the competence or flexibility to make micro decisions in the medical sector).

I have little doubt that adoption of Daschle’s proposals would be an important first step in reforming the provision and financing of health care in this country. Simply ensuring that individuals are able to obtain coverage at reasonable cost would be a dramatic step forward in ending the scandal of this rich country having so many of its citizens without medical insurance coverage. Competition will help to some extent in curbing the excessive administrative costs that characterize the private health insurance business in the United States. By moving closer towards universal coverage, the shifting of costs from uninsured to insured would be reduced, removing one source of the present pressure for rising costs. Daschle’s proposal also focuses on the potential for beneficial spillover effects from the Federal system on the approach taken by private insurers in terms of benefit coverage and in the application of cost-effectiveness standards in judging the efficacy or superiority of new drugs, sophisticated diagnostic tests, medical devices, and surgical procedures.

But any health care reform initiative in the U.S. must also address certain basic financial realities about the present situation (many of which are recognized by Daschle in his book), even before we consider an extension of coverage:

• The U.S. spends far more on medical care—by a factor of roughly 1.5:1—than any other industrial country, with health care costs now approaching 17% of GDP;
• All serious scholars suggest that it would be difficult to envisage containing spending at the current share of GDP; the most optimistic scenarios involve expenditures rising at a rate 1 percent faster than the growth of per capita GDP and the more realistic scenarios suggest an even faster rate of growth (see the recent forecast of the Center on Budget and Policy Priorities (CBPP), which largely echoes similar earlier forecasts by the Congressional Budget Office); (2) (3)
• Such a growth in Federal spending would simply not be affordable without dramatic increases in taxes or cuts in spending;
• Such growth in overall health care spending would also weaken the competitiveness of American business and further erode living standards of wage earners; and finally,
• Perhaps even more frightening, despite this high level of spending on medical care, a substantial share of our population is uninsured and our performance on indicators of health are below those of our peer countries.

So this means that any serious reform proposal must provide an answer to the following key questions:

• Will it ensure universal insurance coverage to all Americans?
• Will it contribute to an improvement in basic health indicators in this country?
• What would adoption of the proposal entail in terms of the growth of health care spending? Would it prevent the growth of spending as a share of GDP? Or would it continue to imply a rising share?
• Would there be full transparency as to how any further increases in spending would be paid for? By higher taxes? Cutbacks in other spending? Higher borrowing?

When I read Daschle’s book, I worried about whether his proposed initiative would be sufficient to address the last two questions posed above. I believe that much remains to be determined in judging whether the Daschle proposal will be able to contain the variety of cost pressures. But what gives me some hope is that Daschle’s discussion clearly recognizes most of the key challenges that will need to be addressed if these cost-constraining imperatives are to be tackled. In particular, he comments on the high administrative costs in the insurance industry; the substantial level of spending on pharmaceuticals and medical devices, the significant costs associated with malpractice insurance; the problematic duplication of high cost technologies in many parts of the country; the undesirable incentive of medical practitioners to shift costs to third-party insurers; the substantial proportion of medical expenditures concentrated in the last year of life; the weakness of America’s efforts at prevention (illustrated most starkly by the epidemic of obesity among young Americans); and the relatively high cost of medical manpower relative to that prevailing in other industrial countries.

To give greater confidence that Daschle’s proposals would address the problem of rising medical outlays, I would make the following suggestion. In formulating the role and policy responsibilities of the Federal Health Board, I recommend that its explicit policy mandate should include—in addition to the objectives of universal coverage and a good standard of medical provision—the goal of constraining the trajectory of overall US medical outlays (as a share of GDP) to a given target path. This path would reflect both the dangers to fiscal solvency posed by the current health expenditure trajectory as well as the opportunity costs and competitiveness challenges posed by a rising share of medical outlays in GDP. Adoption of such an explicit policy mandate for the FHB would parallel the recognized need for a policy mandate to guide the difficult monetary policy tradeoffs faced by the Federal Reserve Board (viz., “to promote effectively the goals of maximum employment, stable prices, and moderate long-term interest rates”).

Note, I argue that the FHB’s target would not simply be limited to constraining the growth of Federal spending. I share the conviction of the CBPP that reform that does not address the fundamental cost-increasing pressures in the entire medical care sector would be insufficient. The recent CBPP report cites both David Walker (former head of the GAO) and Peter Orszag (the incoming head of the OMB) making this argument. What would be important is that the FHB is in a position, over time, to take the requisite actions in its decisions on coverage and standards to influence the various pressure points underlying the current forecast cost trajectory. Note, I also do not rule out the possibility of some modest rise in the share of total medical spending in GDP. Such an increase might reflect the conscious choice of the American people that the gains afforded in better health would be worth the cost ( a point that has been made by David Cutler of Harvard University), as long as the burden of bearing this cost is equitably and transparently borne. (4)

I should also underscore what I believe should be a final important part of the task of the FHB. Specifically, it should help develop a greater understanding of how other industrial countries—faced with exactly the same set of pressures in terms of the availability of new and more sophisticated technologies in the context of aging populations—have made decisions to keep medical outlays within bounds. It should also work with other US government and private agencies to ensure that there is full transparency to the American people as to how the costs of delivering results in terms of medical care are being borne by different groups within the society. We continue to need a more transparent discussion of what medical care costs, what results and benefits we are getting for our high spending, and what are the difficult decisions that we must confront as we examine the costs and benefits of the ever-improving availability of new technologies of medical care.


www.petersheller.blogspot.com
www.petersheller.com

(1) They suggest that a government-run insurance program modeled after Medicare could give such a program the “clout to bargain for the lowest prices from providers and push them to improve the quality of care.”
(2) Richard Kogan et all, The Long Term Fiscal Outlook is Bleak: Restoring Fiscal Sustainability Will Require Major Changes to Programs, Revenues, and the Nation’s Health Care System (Center on Budget and Policy Priorities, December 16, 2008)(see http://www.cbpp.org/12-16-08bud.htm). They note that for the past 30 years, costs per beneficiary throughout the health care system have been growing approximately 2 percentage points faster per year than per capita GDP.
(3) It is also important to emphasize that the very little of this growth would reflect the aging of America’s population.
(4) David Cutler, Your Money or Your Life (2005).

38 comments:

Amanda said...

With various health care reform bills floating around both the House and the Senate, President Barack Obama is pulling out all the stops to get the votes that the bill needs, which is good news for the public option. President Obama continues to rally behind health care reform. I am really concerned that the fiasco of this reform may make Obama a one-term president.

Amanda
my site

終於呀 said...

生命是一頓豐富的宴席,有人卻寧可挨餓........................................

背影 said...

真正的愛心,是照顧好自己的這顆心。........................................

曉豪 said...

人妻自拍18havno185st成人片0204交友單身同學會交友覓戀會館交友聊天室成人 影片日本卡通美女漫畫日本卡通野球拳日本卡通色情網日本卡通h漫日本卡通少女日本女藝人圖片網站日本女傭a片日本女優名字日本女優圖庫日本女優姓名視訊 辣妹sex520免費影片色情a圖cu成人bt情色 網a圖打飛機專用網成人影城微風成人sex999免費影片情色聊天松島楓免費影片0410 免費視訊聊天網維克斯成人999無瑪試看圖av影片下載網際論壇曼雪兒追追追曼雪兒黃色小說曼雪兒色 f 情小說曼雪兒色情免費小說曼雪兒色情小說

婉婷 said...

TAHNKS FOR YOUR SHARING~~~VERY NICE.................................................

邦雄 said...

任何你憂慮的事,你都應該去採取一點行動,不要只是在那邊想..................................................

冠伶 said...

乳交挑逗淫婦色情俱樂部成人色情成人影片視訊網愛聊天室免費色情網情色區火辣美女情色性愛成人影音聊天成人色情網站全裸美女圖片成人裸照sex辣妹裸體美女全裸圖成人區av女情色內容情色自拍貼圖成人色情網性愛論壇一對多性伴侶成人聊天室撫摸淫美成人論壇女人奶頭女生自慰影片台灣女優美女視訊一絲不掛一夜正妹成人影像巨乳大奶子情色性愛貼圖情色王國做愛視訊火辣情色台灣情色網情色聊天網性愛技巧淫娃情色成人巨乳辣妹性愛知識性經驗

80808waldod_brogden said...

happy to read~ thank you!........................................

TemikaGalia25 said...

憂能傷身,保重哦!........................................

韋于倫成 said...

Learn wisdom by the follies of others. ......................................................

佳蓉 said...

78論壇 A片,成人影片分享 080視訊聊天室 666成人 視訊交友網 xvideo免費影片 視訊美女ws888 6k聊天室辣妹視訊 A片-免費視訊 視訊美女mybank sex888影音視訊聊天室 影音情人趣味 85cc免費影片 視訊激麻館 禁地論壇成人 情色視訊 成人影片情色網 bt成人論壇 18成人avooo 玩美女人試看片 hilive tv視訊妹 免費聊天firework av999免費影片 avdvd無碼影片成人情色 一葉晴貼影片av127 520聊天室 一夜情視訊聊天室 視訊聊天室交友 免費視訊辣妹avdvd一夜情 1元視訊 網愛聊天 250av女優免費影片 免費影音視訊fm358 sex女優王國情色 嘟嘟情人色網 dvd 台灣18網 視訊交友雙贏論壇 色a金激麻館 性愛故事性愛文學 凹凸情欲網 成人視訊happylife 視訊聊天交友mm358 免費視訊辣妹sex女優王國 情色香港論壇 亞洲情色貼圖區 日本 a 片自拍偷拍網站情色小說 免費avi影片下載 台灣情色視訊網 17358 視訊聊天室 日本a片免費下載 情色影片免費觀賞you tube影片下載

柏勳 said...

呵。。。。好可愛~~..................................................

07_TeddyF_Silvey0 said...

More haste, less speed............................................................................

啟佐 said...

女傭調教 女生自衛 夫妻交換 大腿內側 夜未眠成 嘟嘟情人 嘟嘟圖片 同志色教 吉澤明步 台中夜店 台北夜店 台灣同志 台灣ki 出包王女 凹凸電影 凌虐俠女 免費女同 免費女傭 免費圖片 免費同志 免費動畫 免費黃色 免費貼影 免費色片 免費dv 免費線上 -qq美美 jp素人 h文小說 辣媽寫真 辣媽哺乳 黃色珍藏 麗的線上 貼圖片區 高雄夜店 視訊kk 西洋美女 電影線上 阿賓小說 阿賓色慾 蓬萊仙山 色片直播 美女自衛 美國色片 美美色網 線上收看 線上動畫 素人寫真 素人大全 短片線上

靖福 said...

上班好累哦,看看部落格轉換心情~~~先謝謝啦!! .................................................................

彥霖 said...

這麼好的部落格,以後看不到怎麼辦啊!!......................................................................

vickiekurt said...

死亡是悲哀的,但活得不快樂更悲哀。......................................................................

asdas said...

人不能像動物一樣活著,而應該追求知識和美德....................................................................

雅慧雅慧 said...

幸福不是一切,人還有責任。............................................................

宥妃宥妃 said...

與其期盼別人疼你,不如自己疼自己。..................................................

吳婷婷 said...

Seeing is believing.百聞不如一見............................................................

吳婷婷 said...

Practice makes perfect.............................................................

洪淑桓洪淑桓 said...

人生中最好的禮物就是屬於自己的一部份..................................................

陳韋夏陳韋夏益東富益東富 said...

從來愛都不知它的深度,非得等到別離的時候.................................................................

宥妃宥妃 said...

真正仁慈的人,會忘記他們做過的善行,他們全心投入現在的工作,過去的事已被遺忘。..................................................

莊雅和莊雅和莊雅和 said...

你不能決定生命的長度,但你可以控制它的寬度..................................................................

佳瑩佳瑩 said...

所有的資產,在不被諒解時,都成了負債.................................................................

李威昌v彥霖 said...

愛情不是慈善事業,不能隨便施捨。.................................................................

建葉葉輝 said...

上來逛逛,踩個腳印給你~~~..................................................................

秋珍雅昀 said...

幸福不是一切,人還有責任。............................................................

子吳吳豪 said...

Knowledge is a treasure, but practice is the key to it.................................................

王辛江淑萍康 said...

向著星球長驅直進的人,反比踟躕在峽路上的人,更容易達到目的。............................................................

麗王王珠 said...

來給你加油打氣!!!保重!!!............................................................

峻胡邦慧v帆 said...

來看你了~心在、愛在、牽掛在,幸福才會繁衍不息^^...............................................................

怡禹玄禹玄君 said...

人因夢想而偉大,要堅持自己的理想哦!............................................................

于庭吳 said...

文章雖然普通,但意義卻很大~~^^~~ ..................................................

黃英吳思潔吳思潔邦 said...

精彩的部落格 值得一推再推 支持你......................................................

homeworkpando said...

it is too good from other post really appreciate all recmond all readers comments on post

eco 372 final exam


http://eco372finalexam.weebly.com/