Reform As a Party Game

Do you remember the party game someone starts by whispering a few words into the next player’s ear?  The message gets passed from player to player until it has gone around the room.  The final version is compared with the original message—and the end result is almost nothing like the original.  The difference is usually worth a good laugh, too.  The course of health reform over the past 15 months reminds me of this game.  However, the game is not over, and the final result will not be funny. 

We all should remember the message that started the game: health care has gotten so expensive that something must be done—now—to stop the rising costs.  Less than a year ago, everyone in Washington agreed that cutting expenditures on health care was absolutely essential to economic recovery.   A bipartisan approach to solving health care’s problems seemed possible because Republicans and Democrats were “on the same page” of cost containment.

How the message changed as it got relayed through the party!  House Democrats just passed a Senate bill that will dramatically increase overall spending on health care.  According to estimates of the Congressional Budget Office, the law the president signs today will increase spending on health care by nearly one trillion dollars over the next decade. 

The law’s presumed deficit reduction gives a false impression that health care spending is being brought under control—but nothing could be farther from the truth.  Under the law being signed today, spending on health care will still rise by nearly a trillion dollars between now and 2020.  The federal government simply doesn’t plan to incur more debt to fund the increase.  Providers, payers, employers, taxpayers, and consumers will make up the expensive difference.     

More Americans will have health insurance under the law (not necessarily the same thing as getting access to health care, but that’s another matter).  Nevertheless, containing cost—not expanding access—was the important message that got lost at the reform party.  The game is not over because Senate approval of House “fixes” provides additional opportunities for changing the outcome over the next week or two.  And then the courts will be asked to have their say.   

Nevertheless, have we made progress if the endgame has nothing to do with the message that positioned reform as a top political priority in the first place?  How are we going to eliminate the inefficiencies in our health system and reallocate the wasted resources to providing quality care to all Americans?  Shouldn’t we put top priority on building an efficient and effective health system?  I’ve spent the last 20 years proposing answers to these questions.  Please let me know what you think!