Wednesday, December 26, 2007

The most recent research: Single-payer plans will not fix our health care system

A big, serious, wonkish book you need to read:

Michael E Porter (Harvard) and Elizabeth Olmsted Teisberg (UVa), "Redefining Heatlh Care, Creating Value-based Competition on Results"

This is NOT a defense of the current healthcare system nor a hit job by social conservatives; it in fact argues that we should dump our current health care system.

But NOT for a single-payer system. From pages 88-91 (I am shortening some of the quotes to avoid copyright problems; please feel free to check for yourself that I am not distorting what they said:

A single-payer system would have some benefits, especially in the area of insurance coverage. Notably, it would end the practice of excluding high-risk subscriberss from health plans.... In theory, a single-payer could simplify paperwork, because there would be only one health plan and thus one set of forms.... A single-payer could limit price discrimination....

However, a single-payer system would create serious, and in our view, fatal, problems for health care value. It would eliminate indpendent health plans, and thereby eliminate competition among health plans to add value by serving subscribers in their quest for excellent care.... [because] competing health plans can play crucial roles in value-based competition that are inconceivable from a monolithic government entity.

A single-payer system would create a government monopoly with absolute bargainin power relative to other participants.... In time, rationing of services and deterrents to the adoption of innovative new approaches to care would seem inevitable, as we have seen in other countries.

Goverment efforts to oversee practice and to micromanage health care would be launched with the best of intentions. However, as we have already know from the experience with managed health systems such as HMOs, top-down administrative control of medical decisions often compromises patient care, retards improvements and innovation, and limits patient rights....

While it is theoretically possible for a single-payer to make consistently good decisions above services, treatments, processes, and reimbursement rates, this is unlikely, especially in what would be a very large system. And when questionable choices are made, the checks and balances of competing health plans would be absent. Providers and patients would have no recorse except the legal system and political pressure, both of which are slow [and] expensive....

It simply strains credulity to imagine that a large government entity would streamline administratio, simplify prices, set precies according to true costs, help patients make choices based on excellence and value, establish value-based competition at the provider level, and make politically neutral and tough choices to deny patients and reimbursements to substandard providers....

Note that I am quoting the summary section; but there are hundreds of pages of data here that you need to read and evaluate for yourself.

That's the key, by the way: fear anyone who won't show you his or her sources, or who maintains that to ask questions or argue policy somehow favors keeping people uninsured or putting huge bonuses in corporate pockets.

There is a HUGE potential downside to single-payer; to point this out is not to shil for anyone, but to provide all sides in a critical debate.

After all: remember this. Adopting single-payer in Delaware is essentially a one-way proposition. Doing so will effectively change the pre-existing health care structure in such a way that we can't go back.

Common sense suggests that you check (A) the depth of the water and (B) your ability to swim before you make that irrevocable decision to jump off the diving board because "everybody else" thinks it is the thing to do.

1 comment:

Anonymous said...

Steve you are a brave man. I just read the back and forth on FSP about healthcare free for all! Wow. Good work.

Nobody mentioned over there that anything that is reduced to free will see an instant increase in demand.