Partisanism Muddles the Health Care Debate

Republicans and Democrats fight over the goals of health care policy, when both parties have legitimate goals that the other should acknowledge. Republicans want to encourage individual control over their health care. Democrats want to make sure that everyone is covered. Why do we have to choose between these two goals, especially when both sides agree that costs are out of control?

True, the two parties generally disagree on certain matters of fact and have somewhat different priorities. Republicans blame regulation for high costs, while at least some Democrats blame high costs on unnecessarily high profits. Democrats are often willing to sacrifice supposed innovation in order to lower costs and equalize access to care, while Republicans tend to justify high costs (those not attributable to regulation) as necessary to insure the optimal development of new technologies that keep American health care moving forward.

There are some factual issues that separate the parties, albeit factual issues that contain major evaluative components. Nonetheless, there is no good reason why we cannot acknowledge that (a) greater individual responsibility and a better informed medical consumer can lower costs, while also acknowledging that (b) drug companies and insurers can afford to take less profits, and (c) that covering everyone even the chronically ill should be a priority for which everyone, especially the most well off, should be ready to pay.

The discussion in today's Journal illustrates the sad state of partisan debate on health care. The Bush administration and its National Economic Counselor Allan Hubbard are pushing hospitals to be more forthcoming to patients about the prices of treatment. They repeat the standard Republican line: Consumers aren't taking responsiblity for their care and you can see this in the fact that they don't put any pressure on hospitals (and insureres) to disclose what patients (and insurers) are paying for care. We think of health care as free, therefore we take no responsiblity... blah, blah, blah.

Against all of which Ira Magaziner says that health care will never be like other markets: "the younger and healthy are the ones who benefit. That's not the way to run a society."

So Mr. Magaziner knows what age group votes. Good for him. But what would be wrong with the Democrats saying: "Sure, we want more informed consumers who can choose covererage wisely and to some extent evaluate what degree of treatment is necessary. BUT, we also want those who could not afford insurance to get coverage and that is going to have to come from the profits of drug companies and the taxes of the well-to-do."

And what can't the Republicans say: "Yeah, we were right when we said that the government should not control what kinds of health insurance you can have. But we admit that the insurance market on its own could never provide cheap and good enough covereage to everyone... even if it would provide a more attractive and efficient menu of plans in the absence of regulation. After all, some employees' services simply are worth much more money than others and, therefore, their employers are willing to pay more for their care."

That would be nice!

Instead our President is limiting his advisors to considering what changes can be accomplished "without legislation." According to his advisor Allan Hubbard, Bush said that he'd "rather not use the crude tool of federal law" to make hospitals and insureres disclose pricing information. But even if federal law is a "crude tool", the Administration's response does not address the question of question of how far making price information available would go toward using health care resources more efficiently.

The Journal does, however, quote an executive from (insurer) Aetna saying that price disclosures would not do much to reduce costs accross the board. But that very executive suggests that some insurers are paying health care providers widely varying amounts for the same services. The industry itself is acknowledging that there is considerable price discrimination in the current market.

It seems that industry is willing to acknowledge market failures and our executive is willing to cast aspersions upon Congressional legislative competence. Perhaps its time to rethink the roles of government and industry in the provision of health care