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InsiderOnline Blog: November 2008

A Plan to Put Experts in Charge of Planning Health Care

The idea of giving an independent Fed-like agency the power to make health care policy in the United States is gaining traction. Tom Daschle, recently tapped by President-elect Obama to be the next Secretary of Health and Human Services, is among the supporters of the idea.

The idea seems to be that interest group pressures play too big a role in influencing congressional decisions on health policy. In explaining his support for the idea, Daschle has stated: “Congress is just not capable of being the manager of a health care system and yet it’s largely Congress today that has that responsibility.”

One way of getting politics out of health care would be to reduce the scope of government’s involvement in health care. For instance, instead of continuing Medicare’s fee-for-service system that puts the government in charge of setting prices for thousands of medical services (and thus invites interest group pressures), Congress could transform Medicare into a defined-contribution system that lets each beneficiary control the dollars spent on his or her behalf by choosing the coverage that is right for him or her.

Daschle’s approach, on the other hand, seems to be to rearrange the government’s deck chairs a little bit, so that the power to set benefit packages and design reimbursement systems is taken from Congress and given to an independent Federal Health Board whose members are appointed. That board’s authority would extend to all government health care programs and might also extend to linking tax exclusions/credits to a standard benefits package.

The proposal is clearly an attempt to do an end-run around democratic accountability. Stuart Butler of the Heritage Foundation writes that Daschle

… wants a Board that really doesn’t have to listen to Americans, or even return White House calls. It would get to determine pretty much what health care we get and what we will be denied. Americans are not going to stand for that, and Mr Obama should reject it right now.

I lived for 30 years in Britain, where regulating access to treatments based on the decisions of faceless health bureaucrats is the norm. The British are known for their wry sense of humor – the acronym for the British board is the appropriately Orwellian “NICE”.

Another problem, as John Goodman of the National Center for Policy Analysis points out, is that insulating policy makers from politics doesn’t make them smart enough to know how to make decisions impacting millions of people:

Sen. Daschle is essentially saying, “I don’t know how to solve these problems; so let the experts decide.” Unfortunately, the “experts” don’t have any idea how to solve the problems either. The reason: on the patient side, all the difficult decisions involve value tradeoffs (which differ a lot from person to person) and on the provider side, efficiency is an economic concept, not an engineering one.

Take cancer care. For most cancers, conventional therapies (chemical and radiation) are not doing much more than buying a few more years of life. On the other hand, about 95% of children with cancer are in clinical trials using therapies that are by definition unproven. So let’s say the Health Board concludes that a few more years of life are not worth the cost, and that we shouldn’t spend a lot of money on unproven therapies for childhood cancer. Basically, the Health Board could close down the U.S. cancer care industry.

For more views on the idea, see the National Journal’s health care expert blog. See also, “Life or death? Ask U.S. health board,” by Stuart Butler, Washington Times, September 18, 2008.

Posted on 11/26/08 07:36 AM by Alex Adrianson

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