My former boss, Tommy Thompson, had a piece in Politico the other day which included a few eyebrow-raising lines. One of them is this:
As a longtime champion of innovative and cost-efficient health care, I cannot support leaving such a critical task up to an unelected board. Americans entrust their elected officials with the difficult task of making decisions like these. That is how democracies work.
I have to shake my head over this, because if it’s what Thompson — formerly an innovative and popular governor of Wisconsin and secretary of Health and Human Services, presiding over the Medicare Part D passage — really thinks, it’s a sign of how much he has shifted toward Republicans like former Senate Majority Leader Bill Frist in support for Obama’s health care law. We don’t want bureaucrats or politicians of the elected or unelected variety deciding whose treatment is worthwhile or makes cost-efficient sense — in practice, this actually means the interested party with the best lobbyists get their way. Instead, we want a little thing called the marketplace to do so, in a manner which is free and transparent, where people can make decisions about their own care.
Nobody can oppose “coordinating care” and paying attention to the roughly 2% of patients who may be responsible for 20% of all health care spending, but this is a far cry from proposals for capitated spending and pay for performance (whatever new code words are used to label or hide it). In my entire life I have never voted for an official to set prices for medical services or ration care for senior citizens. That may be how socialism works, but it is not how “democracies work.” Democracy (actually, “representative democracy,” which we can hope is what Thompson meant) is a technique or system for choosing and removing political leaders, and it works a little better than all the alternatives. It is NOT the way America decides how doctors are paid or who lives and who dies.
And as my colleague Greg Scandlen weighed in:
Tommy Thompson thinks he is being astute, but his article contradicts itself. He says, on one hand that the FFS payment system causes providers to over treat, but on the other hand he cites several examples of organizations that he says work well. But all of these organizations exist within the EXACT SAME payment system as everybody else. So apparently the payment system does NOT dictate provider behavior.
Besides the principles involved, Thompson’s solution just doesn’t work — it’s been proven not to work time and again in Britain and elsewhere.