The New Health Dialogue

Today, on the eve of the White House health reform summit, I published an essay in the New England Journal of Medicine. I called it, “Be Not Afraid.”

"Voters are angry and distrustful of Washington. Democrats have lost their nerve. Republicans, sensing weakness, are closing in for the kill. We have seen this health care reform horror movie before.

Our leaders in Congress and the White House face a fateful fork in the road. They can follow the public’s fear and confusion down the path of perpetual inaction. Or they can lead."

My essay outlines how we can have a happier ending to that movie -- covering all Americans, getting our fiscal house in order, maybe even restoring voters faith in our ability to govern ourselves. That requires government action -- not a government takeover, but government action. Only government can rewrite the rules of the private insurance markets, initiate payment reform, and lead in comparative effectiveness. The health reform bills passed by the House and Senate would signal to insurers that they can no longer profit by denying care or coverage. The bills would signal to hospitals and clinicians that the days of unaccountable fee for service, too, are over.

Foes of reform -- or even some honest fiscal hawk skeptics -- ask why we can’t tackle costs first and expand coverage later. I have three answers. First of all, the CBO has determined that both bills DO cut costs and reduce the deficit. (In my essay, I review the cost-cutting mechanisms in more detail. They are real, not smoke and mirrors.) Second, I deeply believe it is immoral to let the growing millions of uninsured wait another decade until the delivery system changes take root. And third and most important -- it’s just not feasible to tackle costs without coverage. Two-thirds of hospitals already lose money on Medicare, and even more lose money on Medicaid. As I wrote, “To impose serious delivery reform and incentive realignment while leaving hospitals on the hook for the mounting billions of dollars in uncompensated care would bankrupt many and strain most to the breaking point.”

As readers of this blog know, I have long championed bipartisan reform. It would be better for the health system, and better for our country, in the long run if both sides bought in to the hard steps ahead of us. But in the past few months, I saw that the Democrats would have to go it alone. The Republicans are disingenuously shouting that any Medicare savings threatens seniors' health. That shuts off the conversation that we need to have -- and that they have long claimed to want -- about our country’s economic future. Without smart reform now, we will face draconian cuts and price controls in the foreseeable future. Our social safety net will be in jeopardy. Our debt will leave us little choice. 

I hope you read the essay in its entirety. It’s my last request to you as director of the Health Policy Program at the New America Foundation. Today is my last day here. Tomorrow I go back to academia, my roots. But you’ll still hear from me. I will remain involved in the mission to reform and repair and rebuild our broken health care system so that we can cover all Americans in an economically sustainable way.