Bob CollinsAt the same time MPR’s Kerri Miller was hosting a discussion today on where the money goes that’s dumped into health care, and why health care costs so much, a Harvard professor was sounding an alarm that health care reform will lead to rationing, and getting significant pushback from an unlikely source.
“The best solution to this problem of private overconsumption of health services would be to eliminate the tax rule that is causing the excessive insurance and the resulting rise in health spending, Martin Feldstein wrote in a Wall St. Journal column today called ObamaCare is all About Rationing.” Alternatively, Congress could strengthen the incentives in the existing law for health savings accounts with high insurance copayments. Either way, the result would be more cost-conscious behavior that would lower health-care spending.”
Feldstein went on CNBC this morning, where anchor Mark Haines found his view objectionable.
Haines: Why would that lead to rationing?
Feldstein: Because that’s what the administration strategy is. They’ve said they’re going to cut the projected rate of growth on health care spending by 30 percent over the next two decades. That came from a White House study released in June. And the way they’re going to do that is by setting rules for doctors and hospitals, what they call ‘cost effective forms of treatment’ that will limit the kinds of things that can be done.
Haines: And we don’t have rationing now?
Feldstein: We have some of it, but this…
Haines: You bet your bippy we’ve got it. C’mon. You have profit-motivated bureaucrats making rationing decisions.
Feldstein: But I can talk to my doctor. I can talk to my hospital and say, ‘should we do this or not do that?’ And people with private insurance today have those kinds of options.
Haines: And then the insurance company has the final say on whether it actually happens, right? Rationing care.
Feldstein: They turn down very, very few things and, again, it is not the government that’s doing it. So if my insurance company doesn’t allow certain drugs, or doesn’t allow certain kinds of treatment, I can choose a different kind of policy. And the idea as I see it in the Obama proposal is to force us all into a certain kind of spending pattern because the government is concerned — the administration is concerned — about how much the government is spending on health care, and Medicare, and Medicaid, but in order to control that, they want to change the kind of treatments that you and I — outside the Medicare and Medicaid system — can get on our own.
Haines. I’m sorry, but how are you being… how are we being forced into anything? You will be allowed to keep your private insurance.
Feldstein: Yes, but what the administration is talking about, what they describe in this White House report, is what they call ‘comparative effectiveness research.’ In other words: Their studies will say whether a particular kind of treatment is worth the money. And that’s what concerns me.
Haines: Wait a minute! You want to be able to have anything regardless of its cost vs. its effectiveness?
Feldstein: No, I want to make that decision.
Haines: How are you qualified to make that decision?
Feldstein: I and my physician together will talk about whether something is worse spending the money to do. Whether the risks associated with not doing this test or that test are risks that we want to take. And I think that individuals who want to pay out of pocket, there ought to be higher co-payments. But I think individuals and their physicians rather than a bureaucratic process should be making the choice.
Haines: First of all, the private insurance companies are a bureaucracy, so this bureaucrat argument is nonsense. And, second, you’ll pardon me sir, but your argument is a very easy one to make by someone who has money.
Feldstein: But 85 percent of Americans have insurance. So it’s not that we’re talking about a small handful of people who have insurance. And one of the nice things is there’s choice. I can, here in Boston, I can join any of a number of plans and they’re going to differ (Bob notes: He didn’t mention that Massachusetts has universal health care) in the kinds of hospitals I would have access to and the kinds of limits on various things. So there’s choice and it seems to me that’s one of the things that’s made the American health care system so good. That it has stimulated research. It has stimulated new technologies…
Haines: Well I’ll say, again, sir, you have these choices because you can afford them. A lot of people can’t afford them. And we’re 29th in the industrial world in infant mortality. We spend two-and-a-half times what Britain spends for worse outcomes…I’m sorry.
Haines got so worked up, he turned the interview over to his co-anchor.
