Let's look at these ten ideas presented by Gingrich and Goodman (hereafter referred to G&G, to save my typing fingers) and evaluate if (1) they are good ideas; (2) they are practical ideas, reasonably implemented; and (3) if they achieve the two goals of reducing cost and enhancing quality.
- "Make insurance affordable." Turn these stones to bread. G&G purport to pass this idea off as a new one: provide tax credits to individuals who buy insurance up to a limit, which would exclude "Cadillac" health plans from a generous tax benefit. Wait a minute! Didn't I already read that somewhere . . . oh, yes! The Senate health care reform bill! G&G, dressing up an old idea in new semantics doesn't make it a new idea. But it is, after all, a good idea. Here's a better one - and let's see how conservative you really are - let's do away with tax credits and deductions altogether for health insurance. That'll put everyone on a level playing field. The more insurance you buy (or get from your employer), the more tax you pay on the veiled income that employer-provided health insurance actually is. Boy, wouldn't this put price pressure on the health insurance industry when consumers actually have to bear the whole cost of their insurance coverage. Score: Good idea? Yes. Easily implemented? No. Reduces cost? Yes. Improves quality? probably not.
- "Make health insurance portable." Yes, this is a good idea, too. Too bad the Republicans didn't think of it. It's been around for a while, in particular, touted by health care economists. Change federal law so that individuals can buy insurance plans offered to large pools, much like we buy auto insurance. Cut the employer out of the deal altogether. Let the employer increase wages in lieu of purchasing insurance. Or let the employer pocket the difference as a windfall, and then watch their best employees defect to their competition. This will still require regulation of the insurance industry, especially if group insurance goes away and everyone buys his or her own plan. For instance, exemptions or price increases for pre-existing conditions will have to be outlawed. Score: Good idea. Not easily implemented. Reduces cost (possibly). Improves quality: not.
- "Meet the needs of the chronically ill." Newt wants to give the chronically ill their own Health Savings Accounts and put them in charge of their own medical decisions. Newt, we're not in Kansas anymore. HSAs are great for people who are healthy. They don't work for people with ongoing, major medical expenses. You simply can't keep the money in the bank. And lumping the chronically ill in a special-needs plan may (or may not) improve their health status, but it certainly won't save money. It's a bee-line to insolvency. Furthermore, the health needs of the chronically ill are typically very complex and difficult to manage. To expect the patient to expertly manage those decisons (and the money to pay for them) is not only naive, but grossly unfair to the patient. Concentrating on the needs of the chronically ill might be a good idea, but it is NOT health care reform that reduces costs and improves quality. Consolation: it would be relatively easy to implement, by building on the experience of current Medicare Advantage Special Needs plans. Score: 1 for 4.
- "Allow doctors and patients to control costs." G&G use a deceptive tactic here: call a duck an alligator. What they suggest in this paragraph is not cost control by doctors and patients, but changing the reimbursement system so that physicians are paid for good outcomes, not for the number of relative value units (medical jargon for widgets) they produce. Again, G&G, not only has this idea already been suggested - way before either House or Senate bill - but this idea is actually incorporated in both bills. And this is probably the best idea so far. It can be implemented, with some hardship. Already there are demonstration projects in action that reimburse providers based on quality patient outcomes: medical homes, accountable care organizations, etc. This idea will actually reduce costs and improve quality! To bad Newt can't take credit for it. Score: 4 for 4.
- "Don't cut Medicare." Are you kidding?! What's the alternative, Newt? You didn't offer one. How do you plan to avert the program's insolvency if we continue on its current path? Every right-minded economist agrees that to save Medicare we're going to have to cut benefits, increase taxes, or increase age of entitlement (and probably a mixture of all three). The only possible alternative, and it won't solve the problem alone, is to change the way Medicare pays providers (see the paragraph immediately above). Score: F-. The perfect politician's answer: tell people what they want to hear even if it's pure insanity.
- "Protect early retirees." G&G write that "more than 80 percent of the 78 million baby boomers will likely retire before they become eligible for Medicare." Not of those 78 million baby boomers bought into the same mutual funds that I did. It's tough to be a millionaire, Newt! It's just so darned hard to keep touch with reality! But let's entertain Newt's delirium for a moment. Say a sizable number of baby boomers do retire before 65. If we reform our health care financing system to provide portable, affordable, individual insurance options, coupled with HSAs, then these baby boomers will be able to continue their insurance coverage until Medicare kicks in. And they'll probably have to continue that coverage afterward to make up for what Medicare will no longer be able to cover. Score: OK idea. Somewhat reasonable to implement. May or may not save money. Has no effect on quality.
- "Inform consumers." Patients need "clear, reliable data about cost and quality," write G&G, before they can make decisions about their care. How true. In fact, Medicare is already publishing data (www.hhs.medicare.gov) comparing hospitals and nursing homes. Eventually, this type of information will be available for all providers. True, it's not there yet. However, even with reliable data on quality and cost, patients are still woefully unprepared to make decisions about appropriate therapies. They will still need expert advice from their physicians. Score: well, Newt didn't think of this one either, and this idea is already in the Democrats' current plans.
- "Eliminate junk lawsuits." I agree. Score: 4 for 4. And damn those Democrats for being in the breast pocket of the trial lawyers' lobby.
- "Stop health-care fraud!" Thanks, Newt! I'm glad you thought of that. What's wrong with those crazy liberals? Why didn't they think of it? We can all go home now. Here's one: End the war. Or, here's another one: End World Hunger! No, wait: even better: End Global Warming! Peace in our time! There's no place like home! Seriously, even if the figure G&G throw on the page - $120 billion annually lost to fraud - it's a drop in the bucket compared to what we need to do to reduce costs. News flash, Newt: there are a couple of guys running around trying to stop health care fraud. They work for the OIG. And yes, G&G, you're right in implying that massive adoption of electronic medical records and transactions will help to reduce fraud. Wait a minute . . . didn't somebody already talk about electronic records? No, it wasn't ... omigod, yes, Ted Kennedy, demigod poster child of socialized medicine. Wasn't that the whole point of the Kennedy-Kassenbaum act? Newt! What a strange bedfellow for you!
- "Make medical breakthroughs accessible to patients." Good idea: maybe. Every time the FDA does speed up the process, the other half of America becomes hysterical about the FDA being in bed with the drug industry, foisting expensive and dangerous treatments on us without carefully vetting them. Cutting FDA red tape - will that reduce costs? Most assuredly. Will it increase quality? Probably quite the opposite. Making medical advances rapidly available . . . wanna see health care costs eat 40% of GDP? This is a good start. We have to find a way to balance medical technology enhancements with affordability and safety. Another good idea on paper. Not practical. Certainly not cost-effective. Probably not quality enhancing.
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