September 17 2010
Intention Does Not Equal Outcome
I always try to keep in mind that liberals and conservatives share a lot of goals. We all want the economy to recover. We all want more Americans to be employed. We all want more Americans to have better access to health care. We all want to lower costs and fix the budget. Keeping this in mind helps me remember that there are people will good intentions on both sides of the aisle.
Intentions do not dictate outcomes. And so often the disagreement that liberals and conservatives have about the economy, health care, the environment - you name it - is not about the goal, but about the means to the goal. When it comes to health care, the stated goal of making health care more accessible for more people at lower costs to everyone is an admirable goal that we should all work toward. However, the practical outcome of the Patient Protection and Affordable Care Act will not achieve this goal. It's not even right to call it a reform anymore, because as Americans will see it does little to reform the system, but only adds to the complications, regulations, and bureaucracy of the broken system that was already in place.
Ben Heineman, Jr., has an excellent piece in the Atlantic this week that details the differences in the intentions of the March health care law and the probable actual outcome. He focuses on the inability of Obama's health law to lower costs:
Thus, many of the policy problems driving costs up remain--fee for service, imperfect limits on utilization, lack of patient ability to make choices based on cost, provider and insurer incentives to increase, not cut costs etc, etc.. To be sure, there are small, experimental reforms--pilot programs--in the legislation to address some of these problems such as a movement away from "fee for service" payment to a single thirty day fee for all inpatient and outpatient services relating to a certain procedure to give clinicians an incentive to work together to minimize complications and return visits. But, at least for now, the actuaries don't credit these pilot programs with much cost reducing impact. A broad systematic approach with meaningful targets---combining productivity, competition and budgeting---was not in the cards politically.
And, of course, the politics of both the left and the right which prevented meaningful cost control in the Affordable Care Act (and in the decades which preceded it) have only---if this is possible---worsened of late. The ever more conservative Republicans want to slash government programs (and the increased coverage) over the dead bodies of the Democrats. And the Democrats want to constrain insurance premiums and profit-maximizing in the private sector over the dead bodies of the Republicans. A bipartisan attempt to find the right combination of systemic productivity gains, meaningful competition and appropriate budgeting has receded far over the horizon.
Emphasis mine. It's sad to remember Obama's 2008 presidential campaign and all the voters who believed he was "post-partisan" or would "reach across the aisle." The health care law passed in March 2010 was anything but bipartisan, and as Heineman wrote, "A broad systematic approach with meaningful targets - combining productivity, competition and budgeting - was not in the cards politically." We should reconsider the road we took to reform, move past the politics, and reintroduce the ideals of the free market into the health care system.