Thursday, August 20, 2009

Obama needs a new messenger on health care

In today's Washington Post, columnist David Ignatius makes the argument for President Obama to appoint a highly respected non-political physician to spearhead his health care reform effort, Dr. David Cortese, chief executive of the Mayo Clinic. This makes complete sense.

The article is behind a free firewall. so I'll give the money quotes here.

Reading the transcripts of President Obama's "town hall meetings" this month on heath-care reform is painful. He's preaching the right gospel, but the parishioners are getting restless. The harder he tries to sell his program, the louder and angrier the debate gets -- and the more the general public tunes out the politicians.


First, [Dr. Cortese] thinks Obama has made a mistake in moving toward the narrower goal of "health insurance reform" when what the country truly needs is health system reform. Imposing a mandate for universal insurance will only make things worse if we don't change the process so that it becomes more efficient and less costly. The system we have is gradually bankrupting the country; expanding that system without changing the internal dynamics is folly.

Second, Cortese argues that reformers should stop obsessing over whether there's a "public option" in the plan. Yes, we need a yardstick for measuring costs and effectiveness. But we should start by fixing the public options we already have.

Cortese counts six existing public options that should be laboratories for reform: Medicare, with its 45 million patients and a fee-for-service structure that all but guarantees bad medicine; Medicaid, with an additional 34 million beneficiaries; military medicine, through which government doctors deliver state-of-the-art care; the Department of Veterans Affairs, which has improved performance at its hospitals by embracing new technology; the "Tricare" insurance plan for military retirees; and the Federal Employees Health Benefits Program.

The United States may have the best universities, hospitals, physicians and technology on the planet, but the failing is that we lack a system that works. This is a fatal flaw that is bankrupting our nation. Health care is delivered my a mish-mash of professionals, allied industries like drug companies and device makers, hospitals and payers with no real order or universal goal. Incentives and competitionare designed in such a way that can only increase costs with each passing year. This needs to be turned around.

Instead of creating a brand new public option, perhaps an alternative would be to fix and expand the public options we already have: allow people over 55 to opt into Medicare for a fee, and allow the underinsured to buy into the Federal Employees co-op or the Tricare military plan, etc.

Obama never had message control on health care and the opponents to reform have been preparing for this fight for a long time. I doubt the reform can be salvaged at this late date with an off-year election year coming, but if there is a chance only drastic maneuvers can do it.

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