Thursday, March 14, 2013

Fwd: qotd: Steven Brill on using single payer to "clean up the system"

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-------- Original Message --------
Subject: qotd: Steven Brill on using single payer to "clean up the system"
Date: Thu, 14 Mar 2013 08:16:45 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

March 14, 2013
Experts debate all-payer setups vs. Medicare for all
By Brett Norman

Health care prices are too damn high.

That's the punch line to the provocative Time magazine piece "Bitter
Pill" by Steven Brill, who laid out his diagnosis of the problem
Wednesday at a Center for American Progress panel.

He cited sky-high hospital executive salaries and operating margins,
monopolistic and opaque pricing by providers and a fearsome lobbying
force — many times larger than those of the oil and gas or defense
industries — that has beaten policymakers into submission.

"The lap-doggery to the health care industry is bipartisan," he said.
The article has sent hospitals and other stakeholders to the wall in
defense of the system, and it's fueling debates in policy circles.

But while many policy experts agree with much of Brill's diagnosis of
factors that are driving up costs, there's far less consensus on what to
do about it.

Brill said the voluminous feedback he's received since publishing the
article breaks down along two lines. Conservatives believe consumers
need to have more "skin in the game" — to pay more of health costs so
they become more conscientious shoppers and put pressure on providers to
more efficiently compete for their business. And liberals see the
solution in Medicare-for-all, a single-payer system, amplifying the
negotiating might the federal health care program already leverages to
keep costs down.

Brill rejected the single-payer possibility as impractical in his
article but now says that he is increasingly siding with that camp.
"It's sort of the cleanest way to clean up the system," he said.

Brill believes that the federal health care law in general does little
to control costs and will most likely drive up the cost of insurance
because of new requirements for more robust coverage.

He gave little credence to the Beltway policy wonk goal of transforming
the health care system away from paying for quantity of services
provided to paying for health outcomes and the quality of care. He said
similar efforts to move the legal profession away from billing by the
hour and toward meeting performance benchmarks have either failed or
proved more expensive.

Comment: Steven Brill provided such a convincing argument for using
Medicare as a universal program to control health care spending that he
now seems to be convincing himself that we should look beyond the
current approach of dismissing single payer as impractical. As he says,
single payer is "sort of the cleanest way to clean up the system."

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