Thursday, January 14, 2010

Getting the Facts, Just the Facts about Health Care Reform

Information and misinformation is the name of the game. The plethora of articles and blogs that have been written or aired have and are still being written about the health care reform bills soon to be heading to the conference committee for reconciliation. Interest in the bill’s provisions is a good thing. Without scrutiny, debates, even falsification of facts and/or intended consequences democracy is blemished. Let me dwell a bit on that.
Some of you may recall a TV series where the actor utters the words: “facts, just the facts”. I suppose that was in relation to some narrative involving a complaint, a report on some thing or another. The idea was to cut to the meat of the issue in order to come up with the appropriate response, for without the facts and “just the facts” there would be many responses, some appropriate, others not.
The reason for this reminiscence is to assure one and all that we are indeed a democracy. One and all have the right, not only to applaud “rulers” for their efforts on our behalf but also to scorn these efforts. We are neither of the same mind, convictions, nor temperament. One may look at a picture and see a bright sky; another would see a storm looming on the horizon. No right or wrong there. One calls it as one sees it.
What prompted me to choose the title for this blog is the title of an article written by a fellow economist: Jonathan Gruber of MIT, “Getting the Facts Straight on Health Care Reform “, appearing in the New England Journal of Medicine (December 24, 2009). The author takes on the most common critiques levied against the health care reform bill passed by the House of Representatives and the bill that was then before the US Senate (since passed). The main thrust of the article is to refute these claims, but in particular the charge that the reform “represents a government takeover of the health care”. Other refuted claims (six in all), deal with some aspects of the bill(s), from cost containments, to erosion of the Medicare program. These “false” claims which are enumerated and analyzed by Dr. Gruber are not likely to go away any time soon. In a democracy they should not. False claims, if indeed false will die down eventually; their contribution is to sharpen the debate and the public awareness to the issues. Moreover, these claims and counter claims teaches us how to sort out the facts, the “just facts” from the myriad of claims for and against the reform.
Take for example the most serious attack on the reform bill: that it represents a government takeover of health care. One need not lose sleep over this claim. As Dr. Gruber (as well as few others) reminds the Journal’s readers that the Medicare program (defended by those worried about the government takeover) is a government run insurance program which started back in 1965. Had the government had a design on turning it into a national government health insurance program, it has surely failed, or better yet is taking it’s time (55 years) in doing so. But then the wheel of justice seems always to grind slowly!
As I have stated earlier about information being fundamental to the survival of democracy, one need not go too far back in the 19th and the 20th centuries to ascertain that the facts, the true facts chase the false facts out of circulation. In this New Year we shall embark on a new venture called Health Care Reform. In an earlier blog, I have put down the definition of reform as ‘to change or improve what was defective’, to ‘change for the better’. At this juncture our function as economists and the function of medical care providers is to sort out its “reform” features so that a judgment can be made as to whether one feels comfortable to call it a reform or a legislation. While waiting for such a judgment to be made, it is worthwhile to revisit the most fundamental issue that faces society today as it was faced many centuries ago: Defining the role of government and the limits to its power.
Economists, especially those of us who study and write about the role of the public sector are not of one mind. However, one thing we do agree on is that the role of the government is to address “Market Failure”. I believe that the question being debated is at the heart of this—whether or not there exists a market failure in the delivery of medical care in the US. If indeed there is a market failure, the issue then becomes: how far should the government go in dealing with the market failure.
This is the question that will be answered, not today or tomorrow, but by generations to come.