Are We Ready to Make the Public Good a Priority?
Anthony Wright’s recent post correctly urges readers to participate in this summer’s health reform debate. If legislation passes, it will have far-reaching impact on U.S. households and the health care system. The priorities and concerns of health care consumers should be central as the discussion unfolds. But what individuals want is only part of the picture.
In an earlier post, I urged readers to consider the sacrifices they might be willing to make in order to assure a fairer, more efficient and higher quality system for all. The lack of response to that post, and to the cost containment topic more generally, confirms that these are not popular or easy subjects. Yet we all must engage. Achieving sustainable long-term reform depends on converting the vague goal of “shared responsibility” into concrete consensus about how costs will be allotted and benefits assured.
So I would pose a few more hard questions:
• For patients with insurance that covers virtually any service you ask for or your doctor suggests: Are you ready to pay more for services that are often ineffective, or that provide reassurance but little clinical benefit? (A recent report [PDF] by the Center for HealthCare Decisions helps tease out what matters most, and what matters least, for coverage.)
• For workers covered by an employer-sponsored health plan with generous benefits: Are you ready to pay more a) in premiums, b) when you get care or c) through taxes?
• For doctors and hospitals that serve primarily privately insured patients: Are you ready to have payments tied to health outcomes, not the volume of services you provide?
• For health plans whose business models rely on developing complex products that “cherry-pick and lemon-drop:” Rather than competing based on the health status of the members you attract, are you ready to compete by demonstrating and developing incentives for health care quality?
President Barack Obama says, with respect to health insurance, “if you like what you’ve got, we’re not going to make you change.” Over the long term, it will be hard to deliver on that promise. What’s more, considering the flaws in quality, affordability and access that characterize U.S. health care and coverage today, it may not be desirable. What makes me, you or any other individual happy is undoubtedly important. When we share resources, however, a broader perspective – thinking not only about private interests but public good – is important too.
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