Critical Condition

It’s Just Not That Easy

When Jake Tapper asked the president what sacrifices Americans would have to make, the president said:

“They’re going to have to give up things that don’t make them healthier.”  Well, gee, that sounds easy. I’ll happily give up things that don’t make me healthy and all will be well. 

Of course, there are two problems with this. First is that it’s just not that simple to find the things that don’t work and then eliminate those things. Nobody tells a patient that they are going to do a wasteful test or procedure, and doctors don’t go to medical school in order to prescribe tests with no purpose and procedures that don’t work. Doctors do practice defensive medicine to protect themselves against malpractice suits, and liability reform — which the president rarely mentions and the House bill does not touch — would help reduce this problem. That said, it is not as if there is a simple black and white line delineating which tests are truly necessary and which tests are wasteful. 

The second problem is that there are many things that Americans do that do not make them healthy — think drinking, smoking, and feeding children exclusively fast-food diets. Saying that Americans will have to give up things that don’t make them healthy is the equivalent of saying that everyone should exercise daily and expecting that it will happen. 

Shortly afterward, the president said that getting costs under control “Will require I think patients as well as doctors as well as hospitals to be more discriminating consumers.”  This sounds to me a lot like value driven health care (VDHC), the notion that we can drive down costs by giving consumers more information about cost and quality and providing incentives to act on that information. This is a good idea, and one that the Bush administration promoted heavily. Health Savings Accounts, which let individuals save tax free for health-care costs while carrying a catastrophic plan, was one of the major ways to promote VDHC. Unfortunately, it is not at all clear that the plans under discussion right now will bring us any closer to value-driven care, which requires consumers to pay part of their cost out of pocket so that they have a sense of how much they are spending on health care. Putting more people on governmental coverage, as CBO has shown that the House Democrats’ bill will do, has the effect of giving people less of an idea of their health-care outlays. This approach will not bring about value driven health care any time soon.  

Tevi Troy is a presidential historian and former White House aide. His latest book is Fight House: Rivalries in the White House from Truman to Trump.