TINKER, TAILOR, PANDER, LIE

Rather than reform health care, politicians engage in bipartisan sabotage

Washington is abuzz over the roller coaster efforts by Republicans to repeal and replace the Affordable Care Act. Bipartisan blame abounds for the problems of our health care system, and that is the likely key to how we can fix them: with both parties working together, regardless of who controls Congress.

The reason is straightforward: Rather than enact serious structural reforms that reward value over volume, bend the health care cost curve down, improve patient preventive and routine care, address chronic illnesses, and fund vital research, members of Congress take the easy way out.

With apologies to spy novelist John Le Carré, rather than solve problems, our elected officials tinker, tailor, pander and lie:

uThey tinker around the edges of health care. Economists across the ideological spectrum understand that serious reform requires repealing the favorable tax treatment of employer- sponsored insurance that arose in World War II as a means for employers to end- run wage controls.

uThey tailor elaborate rules that are difficult to understand, enforce and audit. These complexities virtually invite fraud, waste and abuse into the system.

uThey pander to interest groups and lobbyists. Bills now seem more like appropriations or tax bills in which every favored interest gets a goody that, once delivered, is difficult to repeal.

uThey lie. “If you like your doctor, you can keep your doctor.” “Premiums will go down.” No one told Americans that lower premiums — if they materialized — could be accompanied by higher deductibles and co- payments. Today, we have people with insurance who can’t afford to use it.

This is no way to address serious public policy issues that affect a sixth of the U. S. economy and touch the lives of tens of millions of Americans.

For three decades, I’ve been involved in health policy issues. In the 1980s, at the Office of Management and Budget, I worked on Medicare’s payment systems known as DRGs — diagnosis- related groups. The idea was simple: Medicare reimburses a hospital a fixed amount, say $ 900 for an appendectomy. If the hospital performed the procedure for $ 800, it could keep the extra $ 100. If it cost $ 1,100, the hospital absorbed the $ 200 differential.

One senior OMB official told me, “We’ve finally achieved cost containment in Medicare.” I was skeptical and said so. Within 18 months, lawyers and others figured out how to shift more procedures to outpatient practices that weren’t subject to the DRG limits.

At the Committee for Economic Development, I was part of the Better Health Care Together Coalition in the 2000s and had the privilege of working with Sens. Ron Wyden, D- Ore., and Robert Bennett, R- Utah, on their reform bill, The Healthy Americans Act. The bipartisan Wyden- Bennett proposal offered serious structural reforms. The Obama administration never took it seriously.

A few weeks after Barack Obama took office, I was in the White House’s East Room when he announced to a few hundred health policy experts that the first thing we needed to do was get insurance costs under control and then expand access. Unfortunately, he outsourced the legislation to Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi, and ended up signing a law that did the precise opposite.

Obamacare passed without a single GOP vote. Now, Republican efforts proceeded without Democrats at the table and without public hearings.

When Sen. John McCain in his presidential campaign proposed eliminating the favorable tax treatment for employer- sponsored insurance, some Democrats accused him of supporting a tax increase. Thoughtful Democrats knew that these charges were disingenuous.

Likewise, some Republicans pilloried Democrats who raised questions about deciding what procedures and pharmaceuticals would be covered. These Democrats were accused of favoring “death panels.” Thoughtful Republicans knew that these charges were disingenuous. This dynamic has to change. It’s time for our country to attend to these pre- existing conditions ( so to speak). Whatever approach one pursues must be done in the context of a $ 20 trillion national debt and looming trillion dollar annual budget deficits. We cannot afford an openended health care entitlement. Whether you favor market forces or single- payer approaches, the country must decide in the very near future what health care procedures will be covered and who pays for them.

Members of Congress need to lead the nation in a very public discussion about the future of our health care system. It’s time for our leaders to stop gaming the American public.

Charles Kolb, deputy assistant to the president for domestic policy from 1990– 92 in the George H. W. Bush White House, is president and CEO of DisruptDC, a non- partisan business coalition devoted to structural governmental reform.

C- SPAN2 VIA AP