It doesn't really matter where you live in the United
States; you will have to face the complexities of care
pretty much on your own. In Washington, D.C., however,
we are uniquely positioned to keep an eye on a Congress
that has changed hands and vows to do something to reduce
costs and make the health care system more responsive.
As a first order of business this month, Democrats
planned to take the Medicare prescription drug benefit,
passed by hook and by crook in the dead of night
in
2003, and try to impose some incentive for drug companies to negotiate with
the government for discount pricing.
However, Senate Republican leader
Mitch McConnell, although not a doctor like his predecessor
was, is
a much better political infighter. And he says, "Not
so fast."
In one of the last acts as the majority in Congress,
his party again waited till nearly sun-up on the
last day of business to change a major program; this
time
the administration's prized Health Savings Account. It was a change that could
not only cost the Treasury $1 billion over the next 10 years (a paltry sum
by Washington standards) but also widen the health
services gap between rich and
poor.
Pro-business members did it by raising the limit on
how much a person can sock away in tax-free salary
for purposes of funding the HSA. The health effect
will
be twofold: It will encourage more people of means to pay more attention to
the cost of their health care at more of a tax deduction,
and it will shift a little
more risk onto the backs of those with fewer means to pay for insurance and
fewer opportunities to have availed themselves of
a healthy lifestyle.
To be fair, the Medicare drug benefit plan and consumer-directed
health plans have elements -- not the least of which
is growing popularity -- that both parties
can either embrace or question.
There are no obvious solutions, and this was made clear
in the waning days of the last Congress when lawmakers
authorized a bonus payment to doctors who adopt
quality measures in treating their Medicare clientele.
It sounds good to tie pay to performance the wa
y it is done in the rest of the
free-market economy. But this time, both liberals and conservatives are complaining,
naturally from opposite ends of the equations. Conservatives say the government
has no business telling doctors how to practice medicine, even when the taxpayer
pays for it. Liberals say doctors are supposed to provide quality care and
don't have to be rewarded for it.
And both sides wonder where the "is" is in defining "quality."
