February 5, 2009

Incremental Change We Can Believe In

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During the presidential election the domestic policy of most concern to voters, other than the economy, was healthcare. President Obama ran on a campaign of implementing sweeping healthcare reform aimed at improving both efficiency and access. House Majority Whip James Clyburn has been quoted as saying it is better for reform to occur, “incrementally, than to go out and just bite something you can’t chew,” to which Speaker Pelosi had to rebut. While the current financial crisis may offer an opportunity to move towards universal coverage and an overhaul of the U.S. healthcare system, it is more likely that Obama’s first term (at least the first fiscal year) will be witness to incremental reform.
There are many well-known impediments to a revamping of the healthcare system. These include entrenched interests, political blockades, red tape and not to mention the time needed to form successful policy. Obama’s proposal included a National Health Exchange to bring together insurers and the uninsured, a national health plan to compete with private plans and a range of tax credits and subsidies to improve affordability. Actually implementing these plans would require navigating the government bureaucracy and reorganizing many preexisting government policies. In addition, the nearly $1 trillion stimulus package being pushed through Congress is on the policy agenda now and may be taking the place of some broad healthcare reform legislation.
Some have argued that the current financial crisis is the exact catalyst needed to implement drastic reform. As premiums rise and more people are priced out of insurance, there is a heightened need to increase healthcare access and alleviate the strain that health expenditures place on many consumers. Therefore, the argument goes, the financial problems the country is now experiencing help to magnify the inadequacies of our healthcare system. However, all spending decisions involve a trade-off, and it presently seems as if efforts and money would be better spent solving the strictly financial problems that plague the economy rather than problems of medical care. Of course, these two options are not mutually exclusive, but it is rather difficult to simultaneously restore financial markets and overhaul healthcare, especially considering that President Obama is having a difficult enough time simply finding upstanding people to solve these problems (i.e. Timothy Geithner and Tom Daschle).
Incremental reform is already beginning to take place and it is the logical way to reach the goal of universal coverage, or at the very least increased access and improved efficiency. Pay-for-performance (P4P) as a means for setting reimbursement rates is gaining popularity and has been implemented by Medicare to a limited degree. There have been policies put in place to create incentives for the use of generic drugs rather than brand name drugs and the economic stimulus package may contain approximately $5 billion in health IT spending. More incremental reforms such as these can help improve the foundation upon which a universal coverage healthcare system might be built.
Many argue that the current growth path of health spending is unsustainable. While impending insolvency among entitlement programs needs to be addressed immediately, it is questionable as to whether or not the economy can sustain increases in health expenditures as we have seen in the past. As this debate occurs, health policy will be geared more towards improving efficiency before there are any large reforms to increase access. It is entirely possible that there will be some overhaul of Medicare in the near term, but implementation of complete, universal coverage is far off in the distance. Hence, the moral of the story is that politicians campaign on grand ideas only to fall short of fulfilling their promises. However, the Obama administration and the Democratic Congress deserve some time to prove themselves and only then can they be judged. Maybe to hedge his bets, Obama’s campaign slogan should have been, “Incremental Change We Can Believe In.”