In my last visit to this space, I raised several questions about our network of hospitals in an era of health care reform. Fundamentally though, I had one overarching question: Should we attempt to plan the transition to a more efficient and right-sized network of hospitals, a change that could better serve the needs of our communities today while containing costs, or should we simply wait and let the market do it for us? With perhaps just a hint of presumption, I pointed out one or the other will most certainly happen.
The piece had barely appeared when news from the real world seemed to confirm my prediction. A for-profit chain of hospitals in nearby Massachusetts was granted a license to sell a health-insurance product which limited subscriber choice to its own network of 10 community hospitals and affiliated provider facilities.
The “market” it appeared wasn’t going to wait for us to deliberate. The very change I spoke about was seemingly under way. The PBN editorial page (“Quality, clarity, key to health-plan choice,” Dec. 26, 2011) noted the move and pointed out the need for accompanying quality metrics so that consumers could in fact make an informed choice. This critical element of transparency, essential to making a true value judgment, does not yet exist other than in sketchy and inchoate form.
The paper followed up with its readers’ poll question of the week: “What is your opinion of closed-network health insurance plans, which would cost less by limiting health care provider choice?” Not surprisingly, reader opinion was quite mixed, with more than a representative sampling of responders answering “I don’t know.”
Businesspeople, perhaps more than the population at large, might recognize the question as a mere microcosm of our national political debate. Advocates of central planning see health care as a basic human right, a social program, or perhaps at least a sort of public utility. To their right, the more conservative free market advocates want nothing to do with any public oversight or government interference in what they see as just an industry going through a natural transition. Which view is more correct and what are the policy and decision implications of each?
I see the need for regulation in financial and other markets. I recognize the corrosive tendencies toward monopolization in many channels, and I concede that certain commodity services are indeed public utilities. As a health care reformer for almost half my career, I have become frustrated with trying to force the industry into a market-based model in which it simply doesn’t seem to fit.
I don’t need to be lectured to on the rehashed lessons of Friedrich Hayek or Milton Friedman; much less the army of conservative, think-tank hacks who we all recognize are well-paid to provide intellectual justification for the positions that best serve the financial interests of their corporate sponsors.
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