Wednesday, September 19, 2007

A Point for and Against HillaryCare

The editors of National Review are right to strenuously object to Hillary Clinton's mammoth health care overhaul; however, in the course of their argument, they say this:

For many of the sick, the Clinton plan will mean worse care. She promises to generate $35 billion in savings by insisting on “best practices” and reducing the “geographic variation in care.” These are code words for rationing. And there will be more rationing to come.

Well, yes and no.

First, in the hands of Ms. Clinton and her would-be army of Washington bureaucrats, it is likely that her program would lead to rationing health care. However, the issues raised here, best practices and geographic variations in health care, represent legitimate concerns that should be addressed by both the private and the public sectors. The Oracle, who is not a health care provider, has attended numerous health care conferences and seen the hard data regarding geographic variations in health care. As an example, workers' compensation patients in Tennessee have various kinds of surgery at far higher rates than injured workers in other states, even after adjusting for factors such as industry mix in the state, according to the studies by the Workers' Compensation Research Institute. Whether doctors are providing treatment based on evidence based medicine is a legitimate concern across the health care industry. The extent to which they are not is a little bit, well, scary.

Of course, private insurers are sometimes guilty of denying coverage for treatment for reasons having more to do with financial reasons than medical ones, and Washington bureaucrats concerned about ever burgeoning budgets are likely to worsen that problem. In addition, building a system that properly addresses medical utilization in making coverage decisions is problematic, in that even when payers do it correctly, they tend to be criticized, as consumers tend to trust their doctors more than their insurance companies.

Washington administrators leading the charge in driving coverage decisions will likely be trusted even less. That fact leads to this cruel irony. Perhaps the key issue in addressing health care costs is health care utilization. Amping up the government's role in health care will likely make it more difficult to address that key issue.


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