Charles Kolb, Opinion contributor Published 5:00 a.m. ET July 27, 2017 | Updated 2:39 p.m. ET July 27, 2017<\/p>\n
Senate Majority Leader Mitch McConnell and fellow Republicans.(Photo: Michael Reynolds, epa) <\/p>\n
Washington is abuzz with the collapse of yet another Republican-led effort to repeal and replacethe Affordable Care Act. Plenty of bipartisan blame abounds, and it is likely that future reform efforts regardless of who controls Congress will also be doomed. <\/p>\n
The reason is straightforward: Rather than enact serious structural reforms that reward value over volume, bend the health care cost curve down, improve patient preventive and routine care, address chronic illnesses, and fund vital research, members of Congress take the easy way out. As with fiscal and budgetary issues, Congress keeps kicking the can down the road. Trite, perhaps, but true. <\/p>\n
With apologies to spy novelist John Le Carr, rather than solve real problems, our elected officials prefer to tinker, tailor, panderand lie. <\/p>\n
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They tinker around the edges of health care. Economists across the ideological spectrum understand that serious structural reform requires repealing the favorable tax treatment of employer-sponsored insurancethat arose in World War II as a means for employers to end-run wage controls. <\/p>\n
They tailor elaborate, complex rules that are difficult to understand, enforceand audit. These complexities virtually invite fraud, wasteand abuse into the system. <\/p>\n
They pander to interest groups and lobbyists at every level. Reform bills now seem more like appropriations or tax bills in whichevery favored interest gets a goody that, once delivered, is difficult to repeal. <\/p>\n
They lie. If you like your doctor, you can keep your doctor. Premiums will go down. No one told Americans that lower premiums if they in fact materialized might be accompanied by higher deductibles and co-payments. Today, we have people with insurance who cant afford to use it because of high upfront, out-of-pocket costs. <\/p>\n
This is no way to address serious public policy issues that affect a sixth of the U.S. economy and touch the lives of tens of millions of Americans. We can do better. The fact that we arent is a bipartisan embarrassment. <\/p>\n
For more than30 years, Ive been involved in health policy issues. In the early 1980s, at the Office of Management and Budget, I worked on Medicares service payment systems known as DRGs diagnosis-related groups.The idea was simple: Medicare reimburses a hospital in a given region of the country a fixed amount, lets say $900 for an appendectomy. If the hospital performed the procedure for $800, it could keep the extra $100. However, if the procedure cost $1,100, the hospital absorbed the $200 differential. <\/p>\n
One senior OMB official told me, Weve finally done it. Weve finally achieved cost containment in Medicare. I was skeptical and said so. Within 18 months, clever lawyers and others had figured out how to gamethe system by shifting more procedures to outpatient practices that werent subject to the DRG limits, practicing DRG creep by coding a practice to receive a higher reimbursementor, in some instances, through committing outright fraud. <\/p>\n
There was no cost containment. <\/p>\n
At the Committee for Economic Development, I was part of the Better Health Care Together Coalition in the early 2000s and had the privilege of working with Sens. Ron Wyden,D-Ore.,and Robert Bennett, R-Utah,on their reform bill, The Healthy Americans Act. The bipartisan Wyden-Bennett proposal offered serious structural reforms. The Obama administration never took it seriously. <\/p>\n
A few weeks after BarackObama took office, I was in the White Houses East Room when the new president announced to a few hundred health policy experts that the first thing we needed to do was get insurancecosts under control and then expand access. Obama had the priorities right. Unfortunately, he outsourced the legislation to Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi, and ended up signing legislation that did the precise opposite. <\/p>\n
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Obamacare passed with all of its flaws without a single Republican vote. Republican efforts in 2017 proceeded without Democrats at the table and without public hearings. Whether there will be a truly bipartisan effort to fix Obamacare remains to be seen. Its unlikely. <\/p>\n
When Sen.John McCain in his presidential campaign proposed eliminating the favorable tax treatment for employer-sponsored insurance, some Democrats accused him of supporting a tax increase. Thoughtful Democrats knew that these charges were disingenuous. <\/p>\n
Likewise, some Republicans pilloried Democrats who raised questions about deciding what procedures and pharmaceuticals would be covered. These Democrats were accused of favoring death panels. Thoughtful Republicans knew that these charges were disingenuous. <\/p>\n
This dynamic has to change. Sound public policy cannot be conducted in a vacuum, in the dark, or without bipartisan collaboration. <\/p>\n
Its time for our country to attend to these pre-existing conditions(so to speak) and return to the drawing board. Whatever approach one pursues must be done in the context of a $20 trillion national debt and looming trillion dollar annual budget deficits. We cannot afford an open-ended health care entitlement. Whether you favor market forces or single-payer approaches, the country must decide in the very near future what health care procedures will be covered and who pays for them. <\/p>\n
Members of Congress need to lead the nation in a very public discussion about the future of our health care system. Its time for our leaders to stop gaming the American public. <\/p>\n
Charles Kolb served as deputy assistant to the president for domestic policy from 199092 in the George H. W. Bush White House. From 19972012, he was president of the Committee for Economic Development. He now serves as president & CEO of DisruptDC, a non-partisan business coalition devoted to structural governmental reform. <\/p>\n
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