...About Those Health Bill Facts

This article appeared on HipHopRepublican.com

By John S. Wilson


What Flier Got Wrong -

Recently Dr. Jeffrey Flier, Dean of Harvard Medical School, weighed in on the health care reform bills circulating in Congress in an opinion piece in The Wall Street Journal. I welcomed his perspective because I had yet to hear it and firmly believe all stakeholders in the business of health care should be heard from. However, I find some aspects of his argument puzzling and others downright disingenuous.


Flier begins his argument by stating:
“Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.”


Flier exhibits a firm grasp of the many vexing problems that precipitate the need for reform. But what about the solutions that are contained within the Senate and House versions of the bill? He seems to ignore those. These are the three omissions I find particularly troubling.

First, he does not mention that employment-based insurance will be buttressed with a public option. This option would be open to those who are uninsured or are unable to afford employer-based coverage. Also, the public option would directly negotiate payment rates with doctors and providers, instead of using Medicare payment rates. By initiating a new public option plan - that the previously uninsured are phased into over a number of years - Congress is able to extend coverage to the millions who are uninsured without having the adverse effect of overburdening the primary care system, which the state of Massachusetts fell victim to when they passed universal insurance.

Second, to combat what Flier notes as “overinsurance [that] drives costs upward while creating inequities…” the Senate version would implement a 40 percent excise tax on employer-sponsored group health plans with premiums over $8,500 for individual coverage and $23,000 for each family. Such plans have been colloquially known as Cadillac Plans: rarely do they require deductibles, co-payments, other limits or require authorization. And it is thought that they drive up health care costs by inducing people to use more health care resources.

Moreover, insurers would pay the 40% tax when plans exceed these predetermined limits. This will deter insurers from offering these types of plans in the future. And that is not the only cost-slimming measure within either bill being currently debated. The Obama Administration has consistently extolled the benefits of implementing more evidence-based medicine. We know that it is possible. Brent James, Dr. John Wennberg, Dr. Elliot Fisher, and Dr. Jonathan Skinner are just a few of the leaders in the (what I call) evidence-based medicine movement, and their results are notable and can be duplicated.

Third, Flier correctly notes that “…deep flaws in Medicare and Medicaid drive spending without optimizing care”. This is why both programs were ground zero for any meaningful reform. Both Senate and House bills distill between 404-436 billion dollars from Medicare. Over a fourth of that total - between 117-118 billion dollars - , would be cut from the Medicare Advantage Program, which many considered to be a boon to the drug companies in the first place when the program was written into law as part of the Medicare Part D legislation.

In conclusion, it isn’t that Dean Flier did not ask pertinent questions, it’s that it seems as though he did not look to the bill to answer those questions. What I am seeing more and more with this reform bill is a pretty simple fact: to like it one actually has to read it.

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