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  • Obamacare Fails Harvard

    Dr. Jeffrey Flier writes in today’s Wall Street Journal:

    As the dean of Harvard Medical School I am frequently asked to comment on the health-reform debate. I’d give it a failing grade.

    Instead of forthrightly dealing with the fundamental problems, discussion is dominated by rival factions struggling to enact or defeat President Barack Obama’s agenda. The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health—not politics—have been left in the lurch. And as controversy heads toward a conclusion in Washington, it appears that the people who favor the legislation are engaged in collective denial.

    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.

    Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that’s not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost—and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.

    In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care’s dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.

    Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.

    In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system—now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all.

    There are important lessons to be learned from recent experience with reform in Massachusetts. Here, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but—despite initial predictions—increased total spending.

    A “Special Commission on the Health Care Payment System” recently declared that the Massachusetts health-care payment system must be changed over the next five years, most likely to one involving “capitated” payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change—necessitated by skyrocketing costs and a desire to improve quality—are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.

    Yet it’s entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire. Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law.

    Selling an uncertain and potentially unwelcome outcome such as this to the public would be a challenging task. It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation.

    So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.

    We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.

    Posted in Obamacare [slideshow_deploy]

    12 Responses to Obamacare Fails Harvard

    1. Gary, Southern Calif says:

      And this is from H A R V A R D ? I'd say Mr. Obama and his merry gang of criminals need to get real.

    2. Freedom of Speech, T says:

      Of course those supporting this madness are in collective denial!! This is why it is so important that they get 1 or 2 Republicans, so they call it bi-partisianship. This (THEY THINK) provides political cover when it blows up in their face. Of course, everyone knows it is a sham.

      They cannot admit they were wrong in what they propose. They know the costs are unsustainable, no matter the bookkeeping gimmicks Bernie Madoff would be proud of.

      They have the majority. Instead of real bi-partisianship from the beginning to gain support to pass a health care plan (give and take), Nancy Pelosi was arrogant and devisive from the beginning. They wanted to steam-roll this thing and now even their own members know it is a joke. They also HEAR the American people, though they dismiss us as idiots.

      They cannot admit that Americans do not want a socialist/marxist big government future. We are not Russians, Europeans, or Chinese.

      In short, they MIS-CALCULATED. The sad thing is that many will continue this course (knowing the American people will never accept it and ultimately rebell) — even if it destroys our country.

      Now, who are the REAL Patriots?

    3. Tammy, Jacksonville, says:

      This is not the health care reform battle. This only one important battle for health care reform. A well-designed, quality, universal health care system will not be passed with a single massive piece of legislation. If that is your goal in this fight, you will never win. Knowing that, it is important to focus on winning this battle as a strong foundation for the next battle.


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    5. Bobbie Jay says:

      No offense, but if everyone were to think, see and hear with a logical, reasonable mind, it wouldn't take Harvard's dean to see and call it, a failure…

    6. Mark, Sacramento says:

      Our legislators are a bad joke. They lie, and then feign outrage when they are called liars. They steal from the citizens, and then feign outrage when they are caught red handed. They promise transparency and practice obfuscation. A citizen's revolution is at hand. People are fed up…and they won't take it anymore. This isn't politics as usual. This is about the survival of the nation.

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    9. Chris N, Albuquerque says:

      One of the most liberal colleges in the United States and it does not agree with the current proposals of healthcare reform. If this was only printed in every paper in America, then alot of Americans would see that Harvard Medical School which is regarded as one of the finest schools in America does not agree with the current course of actions then why are our elected officals so determined to go down this path.

    10. Grace L, Henrico VA says:

      I have been reading again 1776 by David McCullough. What has happened to our citizens when they elect leaders of very little mental capacity and no moral quality? We see how our forefathers gave everything for our independence and the voters gave it away cheaply.

      I am ashamed to be a citizen of this formally great nation,however, I will never give up standing behind honest representatives to replace these ugly Americans.

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    12. Rita, Virginia Beach says:

      PLEASE, when debate on the health care reform legislation begins in the Senate on Monday, burn up the phone lines, fax lines, and e-mails to your two Senators and other moderate Democrats in the Senate. If you are unfamiliar with how to reach your Senators, you can go to http://www.senate.gov and a page will come up where you can type in the name of your state and all the pertient information can easily be pulled up. You can also call the Capitol switchboard at 202-224-3121 and ask to be connected to the office of your Senator. This legislation, if passed, will have a very negative impact on eveyone in this country. These people must be stopped! Only we, the people, can stop them. Get involved, stay involved, stay busy contacting Senators and never give up or give in.

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