Judging by their unprecedented use of the word “unprecedented” to describe everything the Obama administration has done it appears that they truly think they have fundamentally changed the national landscape in one short year.
Nowhere is this more apparent than in the titanic health care “reform” struggle. The administration cannot seem to grasp the reality or the reasons for the public’s rejection of Obamacare. The White House is correct that Americans want to reform health care and make it more affordable, accessible and understandable. But the people know intuitively that a government takeover, or just a much bigger government role, won’t achieve those goals.
Reforms that would result in improved national health, better access, and enhanced cost effectiveness were well underway under the Bush administration. The kinds of reforms that many pundits have suggested could be achieved if the White House would ditch its overly ambitious plans and start from scratch.
When it comes to some of the most popular elements of “reform,” the Obama team has simply picked up Bush initiatives and represented them as their own ideas.
The Bush administration launched a major initiative to promote use of new health information technology. The Department of Health and Human Services, under two very capable secretaries, Tommy Thompson and Mike Leavitt, launched complex efforts to create interoperable health IT standards, to promote the adoptions of electronic medical records, the aggregation and exchange of data throughout the system, and the use of this data to improve outcomes. The Bush administration also knew that the only way to get a handle on how and why costs were increasing so rapidly and what to do about it, was to have consistent and universal data to examine.
Secretary Mike Leavitt traveled the country tirelessly to promote the creation of health information exchanges–in which health care providers, in cooperation with employers and public health agencies built infrastructures and designed systems to begin the collection of this vital information.
But the difference between the Bush and Obama administrations was that the Obama team sees this data aggregation as the key to centralized control of health care, while the Bush team saw it as the foundation of a value-driven health care system where consumers were informed and empowered in making critical health care choices for themselves.
The Bush administration also launched an aggressive expansion of Federally Qualified Health Centers (FQHC’s) to expand access to traditionally underserved communities, particularly in minority and rural areas. During the Bush tenure, visits to FQHC’s rose over fifty percent, providing easier access to community-based primary care services–the lynchpin to improved overall health in the economically disadvantaged population. These clinics are vital to providing patients with the “medical home” the Obama team often touts, which was the same objective in the Bush administration.
The Obama administration also talks about overall population health, or “wellness,” as if they had invented the concept. They also crow about how they will harness “prevention” to lower health care costs. These ideas were well ingrained in the Bush HHS policies. But the Bush team knew that the government couldn’t wave a magic wand and change behaviors that hold the key to improved health.
Under Bush two new programs came online that offer us a realistic blueprint of how real reform can work and how the government can be a helpful partner in empowering the patient/consumer, better manage cost, and enhance the quality of care. They are also a strong counterpoint to the Obama approach.
The Medicare Advantage program provided beneficiaries the option of enrolling in a comprehensive insurance plan that would end the patchwork of Medicare Part A, Part B, Part D, and private insurance. Millions of Medicare recipients spend billions each year to purchase private insurance to cover the gaping holes in government coverage. Medicare Advantage allowed seniors to get coverage from one private insurer in a managed care construct that better controls costs and delivers better service to the patient.
Medicare paid a higher premium for Advantage plans, which allowed higher payments to providers to encourage participation in the program. Satisfaction rates for Medicare Advantage are sky high and early indications are that they enhance the coordination of and effectiveness of care for beneficiaries.
Democrats want to gut Medicare Advantage because it features private insurance participation. The government’s role is to set standards and subsidize coverage and then get out of the way. Insurers design products to appeal to certain customers and then market them accordingly. Patients maintain choice and can vote with their feet if they don’t like the quality or service they are provided.
The Bush administration also supported and implemented the Medicare prescription drug program. While many conservatives thought it was a costly expansion of a government entitlement (and it was), it was at the same time a sensible add on and maintained the role of private insurance and consumer choice.
Again, the government subsidizes the purchase of drug coverage on a sliding scale according to need. The individual picks an insurance plan according to their wants and needs. Insurers design plans with customers in mind and are financially rewarded by building a better mousetrap. The program overall has benefits on the wellness and prevention side. Since the taxpayer is already on the hook for seniors’ health care, it makes sense to pay for the drugs to manage hypertension rather than waiting for the very costly heart attack or bypass surgery.
The Bush administration also promoted Health Savings Accounts (HSA’s) that allowed individuals to save tax free money to pay for routine health care costs out of pocket while purchasing a low-cost, high-deductible insurance policy for unexpected major health issues. HSA’s have proven very popular for both employers and beneficiaries. For families with routine health issues, they make sound economic sense and also encourage patients to look for cost-effectiveness in purchasing primary care.
In comparison to the proposed expansion of government direct involvement and control over health care, Medicare Advantage, Medicare Part D and HSA’s, offer examples of how the government can help individuals according to need, but allow them to maintain their control over their coverage and care. Because they all represent counter-arguments against to the argument that only a government takeover of health care will work, Democrats hate these programs or want to either eliminate them or make government the dominant player.
The Bush administration was forward looking in its promotion of prevention and wellness programs. It was a pioneer in harnessing information technology to improve the quality of care. The Obama administration simply continued the push for these ideas that were well accepted across the ideological spectrum.
What the Bush team, and particularly Secretary Leavitt did that was the direct opposite of the Obama White House, was try to bring the idea of value back into the health care sector. They knew an empowered and informed consumer would make cost-effective choices for themselves and their families and that the resulting competition and improved quality would lead to more manageable costs and better overall health.