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Conservatives want serious health debate

Many conservative experts said the dynamic of the debate was making it nearly impossible for them to inject their studied, free-market solutions into the discussions.
/ Source: The New York Times

The roiling debate over health care this summer has included a host of accusations from opponents of the plan that have been so specious that many in the mainstream news media have flatly labeled them false.

Far from embracing the attacks, many leading conservative health care policy experts said in recent interviews that the dynamic was precluding a more robust real-world debate while making it nearly impossible for them to inject their studied, free-market solutions into the discussions.

And they said the focus on what they consider misleading or secondary issues was getting in the way of real questions about the plan they believed worthy of consideration.

“There are serious questions that are associated with policy aspects of the health care reform bills that we’re seeing,” said Gail Wilensky, a veteran health care expert who oversaw the federal Medicare and Medicaid programs for the first President George Bush and advised Senator John McCain in his presidential campaign last year.

“And there’s frustration because so much of the discussion is around issues like the death panels and Zeke Emanuel that I think are red herrings at best,” she said, referring to a health care adviser to President Obama whose views on some issues have been misrepresented by opponents.

Dr. Scott Gottlieb, a fellow at the American Enterprise Institute, a conservative research group, is among those making policy-laden arguments against Mr. Obama’s plan that do not lend themselves to easily digestible catch phrases like “death panels” or false but sensational assertions that the elderly will be told to choose euthanasia as a cost-saving measure. But his critique is based on related fears that the plans being discussed would inevitably lead to increased government involvement in personal medical decisions and eventually affect vital services.

Reduce spending, reduce services?
Like many of his conservative peers, Dr. Gottlieb said he was concerned that the administration’s plan would fail to control costs adequately while increasing demands for services. The result, he said, is that Medicare, Medicaid and any new government insurance program would be forced to deny payment for procedures deemed unnecessary.

Administration officials contend that the plan would not cause a draconian increase in rationing by finding savings in Medicare and Medicaid — plenty of which takes place already, people on both sides of the debate agree — because it would be largely financed by cutting waste in Medicare, more than $500 billion over 10 years.

Their argument holds that they can find that money with real efforts to decrease redundant procedures due to poor record keeping — causing a doctor, for instance, to prescribe an expensive test a patient has already had — and the correction of similarly exorbitant inefficiencies throughout the system.

“To put this in perspective, the Medicare savings proposals that the House is considering as part of health insurance reform would constitute perhaps a 6-to-7 percent reduction in spending over 10 years,” said Daniel H. Pfeiffer, a White House spokesman, who also noted that the AARP had agreed with the administration’s assessment that the cuts would not force reductions in beneficial services. “A wide array of experts agree that we could reduce spending by 30 percent without reducing services,” he added.

But, starting out with a general distrust of government solutions, even conservatives who agree that tens of billions of dollars are wasted annually are dubious about the government’s ability to find significant savings without eventually affecting care negatively. They argue that the government is incapable of making such cuts fairly or competently.

Tax policy vs. direct intervention
Some conservatives insist that more of Medicare’s administrative functions should be contracted out to private insurers. Others suggest tax breaks or subsidies for people to buy their own coverage.

A similar idea was once proposed by Dr. Emanuel, whose plan for a voucher system is not being considered by the White House. But it is in keeping with conservative approaches holding that government should try to change the health care system through tax policy rather than direct intervention.

“We profoundly disagree with this notion of a large, centralized restructuring of the health system,” said Stuart M. Butler, a vice president of domestic and economic policy studies at the Heritage Foundation, a conservative research group. “You’ve got to devise a system that starts to change underlying incentives — the policy incentives — and allow a gradual change in the system over time.”

That is not to say that there is much of a consensus among conservative health care policy analysts, who face an intellectual conflict on health care: many proven ways of saving money have tended to result from the sort of centralized decision-making that they have traditionally abhorred.

So while some conservative policy analysts are finding savings in Medicare, many say they fear that government will misuse the information it gleans from studying the utility of various treatments by eventually using the results to dictate care. (Mr. Pfeiffer said, “There is nothing in any of the versions of the legislation that suggests that is remotely possible.”)

‘Ways to spend smarter’
Ms. Wilensky, on the other hand, applauded the administration for financing just such studies to reduce ineffective but expensive treatments.

“We have to find ways to spend smarter and treat smarter so we slow the spending growth rate,” she said. Ms. Wilensky said the entire health care system should stop paying doctors an individual fee for each service they provide patients — something experts say encourages over-treatment and waste — and alternatively, for instance, persuade them to join together with different specialists to offer an array of services for one lump sum.

This idea is widely supported by conservatives and liberals alike, but no proposal to set up this new payment system has gained attention.

“Part of the problem on the Republican side is an unwillingness to say, Let’s find a right way to do this, and let’s go ahead even if all the special interests don’t like what we’re doing,” said John Goodman, president of the National Center for Policy Analysis, a conservative research group.

In the meantime, Mr. Goodman said he hoped his side could do a better job at making clear it had genuine misgivings about Mr. Obama’s proposals.

“I think the critics have approached this in the wrong way; saying there’s going to be a death panel is not the right way,” he said. “The right way to approach it is to put the burden of proof on the administration — tell us how you’re going to do that without denying care to people who are really in need.”

This article, "Conservatives See Need for Serious Health Debate," first appeared in The New York Times.

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