A spoonful of sugar

Health-care reform

A spoonful of sugar
Jun 16th 2009 | NEW YORK
From Economist.com

Barack Obama tries to sell health-care reform to doctors

 

 

 

AMERICA’S health-care system is expensive, leaves nearly 50m people uninsured (out of a population of some 300m) and produces outcomes that are worse than those of many other rich countries. As Barack Obama’s government attempts to hammer out large-scale reform, one important group of practitioners still needs persuading that change is worthwhile: the doctors.

 

On Monday June 15th Mr Obama delivered a speech, pragmatic in tone and offering a wide variety of potential fixes, to the American Medical Association (the leading doctors’ lobby). The AMA is reportedly sceptical of reform, opposing any public plan that would force doctors to participate (although the AMA also says that it would consider any plan under discussion in Congress). Other critics, many Republicans and a few Democrats alike, worry that a public plan as put forward by Mr Obama would damage private insurers, in particular fearing that it would be a back-door approach to a single-payer system.

 

Mr Obama tried to rule that out on Monday, stressing that many Americans are happy with their health care and that he would not want to jeapordise their interests. He also suggested that the public plan would not impose price controls similar to Medicare, the huge programme that insures the old. Mr Obama needs to reassure patients that they would not lose choice and to persuade doctors that they would not see their pay set by the government, if he is to build sufficient support for reform. It is a difficult circle to square.

 

In a nod to the left, Mr Obama touched on the concept of mandates—although he did not use the word itself, instead referring to a possible new “responsibility” to buy health insurance. Making it compulsory for the healthy to buy insurance (which they are unlikely to need for some time) would be the obvious way to lower the average premiums. During his presidential run, Mr Obama resisted the idea of mandates. Now he says he may support them, if exceptions are built in for those who cannot afford to buy it.

 

Mr Obama also took a half-step in the direction of bringing down costs through the Republicans’ favoured measure: tackling the huge costs of doctors’ legal liabilities. Although the president said that he continues to oppose mandatory caps on malpractice awards, he did say that he is open to “a range of ideas” for getting doctors to stop worrying about lawsuits and thus practising expensive defensive medicine.

 

And Mr Obama’s focused on economic arguments. He argued that the uninsured represent a “hidden tax”, whereas new “health insurance exchanges” would bolster competition. Preventative medicine, electronic records and slashing waste would make for a cheaper system. Without reform, the growing costs threaten America’s overall fiscal future.

 

Was he persuasive? After the conference the AMA’s president, Nancy Nielsen, and her soon-to-be successor, James Rohack, gushed with enthusiasm, in particular because of the mention of malpractice reform (trial lawyers represent an important constituency for Democrats, and oppose malpractice changes). But a huge task remains. Lobbying firms in Washington are said to be engaged in frenetic activity on behalf of private insurers, encouraging congressmen and senators to resist radical reform. Competing bills promoting health-care reform are likely to be brought before Congress.

 

One idea doing the rounds is to promote a health insurance co-operative, rather than a government-run programme. Kent Conrad, a Democratic senator with an interest in health, is particularly keen on the idea, and the AMA has made a point of saying it would consider a co-operative. He doubts that the Senate would pass Mr Obama’s proposal for a public plan. Some Democratic sceptics, perhaps even some Republicans, might be persuaded if doctors were ready to back such reform.

 

Another senator, Max Baucus, who chairs the Senate finance committee, says that he expects to see health-care reform legislation proposed in the Senate this week. A health-care plan proposed by Edward Kennedy, which offers proposals close to those of Mr Obama, has been dealt a blow by the Congressional Budget Office, which has offered a preliminary estimate that it would add $1 trillion to the deficit over the next decade, yet would still leave many millions without insurance.