The part of health care reform that progressives have traditionally been most comfortable talking about involves tackling the vested interests of insurance companies. And lately conservatives have cottoned to the strange idea of improving health care by tackling the vested interests of patients. But the core of the issue is and always has been the vested interests of health care providers. Some of the most important aspects of the Affordable Care Act do just this, telling hospitals that they’ll be held accountable for the quality of the care they provide. The idea is to make funds flow to hospitals that do a good job of using the funds in a cost-effective way.
Naturally, as Robert Pear reports, incumbent hospital administrators hate this idea and feel that the government ought to reimburse them for as much treatment as they can sell to patients, regardless of whether or not it makes anyone healthier.
This clash of interests between the legitimate policy concern for public health and providers’ desire to avoid accountability for the quality of their caregiving ought to be at the center of the conversation over health care costs. A greater focus on cost-effectiveness might bring down spending. Or it might mean that spending stays high, but health improves dramatically. Either way, it’s a winner. Instead we’re talking about a mystical alternate reality in which when we shift costs onto patients, we suddenly develop superpowers that allow us to second-guess surgeons’ accounts of how to perform operations.