Specifically, Dr. Jeffrey S. Flier, who happens to be no less than Dean of Harvard Medical School (a fact with which Dr. Flier opens his article, both obviating the usual biographical note appended at the end and reinforcing the stereotype of Harvard types), opines in today's WSJ that the present state of so-called healthcare reform is deserving of a "failing grade."
For those who expect a stalwart of academe to insist that the current bills aren't trendy-lefty enough, we note the surprise that Flier objects on economic grounds. What the present reforms will do, he argues, is drive prices higher faster than would happen otherwise.
Flier offers nothing of an alternative, but he does hint as he assesses the present:
Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.
So the solutions ought to be to reform tax policy to decouple employment and insurance, tax overinsurance, reduce regulation, and reform Medicare and Medicaid away from payment for service. We seem to remember someone trying to do something about such things once.
Despite Flier's throwaway remarks decrying both parties' approaches to the issue, the reality is that his diagnosis would call for the kinds of actions proposed by the Bush administration and instantly torpedoed by Democrats in Congress.
Cost control and quality improvement, Flier says, can't happen when "The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value."
So the solution would be to put patients in charge of their healthcare dollars, with a financial incentive to save. Just the thing that high-deductible policies with health savings accounts would do. Which is to say the very thing that the present administration and Congress refuses to allow to continue, let alone grow. And the very thing for which Whole Foods CEO John Mackey was nearly crucified for advocating weeks ago.
Flier can't say that, apparently. He must respect the rule that people in his position not support such reactionary, right-wing ideas. But it's clear enough what must be done if his analysis has any merit at all.
We continue to think that the Obama-Pelosi initiative is doomed by its stupidity. We are heartened that some of those most deeply embedded in the institutions of the liberal establishment seem to agree.