Austan Goolsbee, a wiry and droll economic adviser to President Obama, was addressing a private Chicago dinner last week when he entered the Death Valley of American politics: health care.
A member of the Council of Economic Advisors, he met amiable resistance while defending the administration plan to The Wayfarers Club — whose 50 members include college presidents, nonprofit leaders, businessmen, a few journalists and Scott Turow — which meets to hear speakers discuss issues of the day. Mr. Obama is a member but rarely appears.
But attendees did fully engage Mr. Goolsbee, including colleagues from the University of Chicago, from which he is on leave. This is unlike Congressional Republicans who are reluctant to attend Mr. Obama’s televised summit on health care next week.
The comedian Jon Stewart has even mocked the House Republican leader, John A. Boehner of Ohio, who has fretted about walking into a “trap.” On his TV show, Mr. Stewart said the summit would be “a public dialogue about important legislation — not Little Big Horn.”
With Republicans nervous, I decided to ask some real health experts what wisdom they would share if invited to the Obama gathering.
“First, I’d ask the president and the Democrats if they have anything more innovative — or anything to promote efficiency and save money — beyond slashing a zero off the amount they pay doctors,” said David Dranove, a professor of health industry management at the Kellogg School of Management at Northwestern.
As for the Republicans, Mr. Dranove would ask them, “Do you have anything meaningful to offer in the debate?” He would note that the overwhelming evidence suggested that malpractice reform would have at best a small impact on spending. And he’d inform them that most health economists believe that opening insurance competition across state lines will not make a dime’s worth of difference for health insurance competition.
Michelle Gittler, medical director of the spinal cord injury program at Schwab Rehabilitation Institute in Chicago, is more focused on the quality of care. “It seems that no one has an interest in putting care back into health care,” Dr. Gittler said, “least of all the people we elect and trust to make thoughtful, big decisions.”
Dr. Gittler would invite summiteers to follow her on rounds so they could see that she can’t send patients to specialists because few of them take Medicaid patients; can’t discharge some because Medicare won’t cover antibiotics at home, meaning they must stay or go to a nursing home, and can’t coordinate care for the chronically ill because the federal Center for Medicare Services has, she said, “run amok with clinical decisions made without input from clinicians.”
Leemore Dafny, a professor of management and strategy at the Kellogg School of Management, would tell the summit that Americans want a low-cost, high-impact solution but are skeptical of top-down cost controls and uncertain savings — and that many want to keep their current insurance.
Ms. Dafny said she would give individuals both the incentive and responsibility to choose their insurance. She would goad the assembled toward a “game changer,” namely equal tax treatment of employer and individual insurance, and the option to use employer subsidies toward individual insurance so people can vote with their dollars and choose the plan best for them.
She made an analogy to buying a car: With the current employer-based system, Americans now have a de facto choice of a $10,000 subsidy toward a Ford Taurus or no subsidy at all. “I’d take a cheap Taurus over no car if that’s my choice in the insurance market,” Ms. Dafny said. “But I’d be willing to take a smaller subsidy and buy my mini-van, which I really need.”
Her research finds that, on average, employees would be willing to give up 27 percent of their employer subsidy to health insurance if they could apply what remained to the plan of their choice. But, she said, “the political world has been basically silent about this.”
Finally, I circled back to Mark Siegler, a Wayfarer member and director of the MacLean Center for Clinical Medical Ethics at the University of Chicago Medical Center, who had given Mr. Goolsbee some grief at the dinner. Dr. Siegler would tell the summit, “You have to rebuild U.S. primary care and organize the U.S. health system based on a foundation of primary care rather than as it is now, the only health system in the world not structured around primary care.”
Would any of this have an impact? On Tuesday, one Chicago daily offered three paragraphs on the capture of a key Taliban leader in Pakistan but six on the theft of a plastic promotional model for a new Alvin and the Chipmunks movie at a Gurnee movie theater. Wisdom may be a tough sell.
it reminds me, not new, that we have put off dealing with health care as a country for so long, that now we can’t get our hands around it. even though we know there are no death panels in the legislation, most people based on polls don’t see any advantage to them.
the anthem blue cross 39% increase in California is another wake up call.
why can’t all these smart people in the Wayfarer’s discussion come up with comprehensive health care plan? we have all these experts but no political will for a solution.
Jim, how about convening a panel of poor and working class people with insurance, without insurance, and some about to lose insurance? See how their views contrast with the Wayfarer’s.
good article.
Jim,
Excellent reporting. Hopefully Goolsbee will take this back to DC.
James this was a good article, it encompasses several of the key issues of the debate and how hard it will be to move to universal health care by increments.
You touched on doctors fear of losing income, malpractice/torts, and defacto rationing (which medicare clearly does today without calling it that). You also covered the economic arguement that giving an individual x amount of money to spend on his/her own insurance plan they will make a sound decision when they are more interested in Alvin dolls than public welfare.
I think Siegler is on the right track calling for rebuilding of the system. Countries like Taiwan and Switzerland have done it in recent years.
Gotta love the US Congress. They’re gonna increase taxes and reduce our wages. What do you think employers will do when it costs more to hire an employee?