Monday, March 28, 2011

How throwing rocks at insurers hurts reform efforts

I’ve gotten into arguments with people about why focusing on insurance is a dead end if you want to reform health care. I think it is actually worse than that, not just an absence of good but an actual bad. Why? Because it encourages the belief that the only thing wrong with health care is that insurers won’t pay claims.  If people adopt that mindset, why would they ever accept any kind of cost control?  For instance…

Here is a pretty good proposal for cost control, through the creation of CCO’s. Those entities would sit between providers and the insurer (the state), and act to coordinate and plan care across disciplines, including oral, behavioral and physical care. They would also promote individual accountability and seek to prevent unnecessary care.

This seems like a cut and dry ACO reform that will save a lot of money for the state. I also think that politically it is dead meat. The CCO concept will be tarred as an HMO, a comparison that is essentially correct. HMO’s were actually even more detested in their day then insurers are now.  I don’t see how the public will accept them without a cogent argument* based on costs and benefits.  Bashing insurers promotes a view antithetical to that argument, that the only thing that matters is getting care paid for and where the money comes from is irrelevant.  It makes it that much harder for cost control efforts like the CCO proposal to succeed.

Maybe I’m wrong about the fate of this proposal, I’d be happy if I was. Time will tell either way.

*I look to the left for this argument because I’m pretty sure there won’t be one coming from the right.

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