Perceptions that the US health care system is dysfunctional and needs major reform go way back. A timeline from the Tampa Bay Times noted President Theodore Roosevelt’s proposal for a national health service in 1912. Nonetheless, as we have discussed endlessly, most attempts at reform failed, and health care dysfunction seems to be getting worse.
One big problem may be that we don’t understand how much discussion of health care reform is driven by those who benefit from the status quo.
A Personal Anecdote
When I began my academic career in 1983, I was often in the audience for talks about how to fix health care by people billed as experts. Often these talks seemed oddly disconnected from the realities on the ground for a junior assistant professor with a lot of clinical and teaching responsbilities. Worse, many of the solutions they offered seemed to entail greater burdens for health care professionals, with no obvious compensation other than the warm feeling that we would be benefiting society. Who else these solutions might benefit was not discussed.
One talk given a bit later stands out in my memory. On November 29, 2001, one Dr John W Rowe gave the prestigious Levinger Lecture at Brown University entitled “Good Health: Can we Afford It?” (referenced here, see items for 11/14 and 11/16) As I recall, Dr Rowe spent considerable time scolding us hard working physicians for overuse of medical interventions leading to endless increases in health care costs, and promising more burdensome bureaucratic interventions to rein in our follies. While promising more burdens on physicians, Dr Rowe did not dwell on how the resulting cost savings might benefit him in his role as CEO and Chairman of Aetna Inc. Aetna had purchased the notoriously physician-unfriendly US Healthcare, and thus had become a big for-profit health care insurer already known for imposing bureaucratic burdens on physicians in hopes of decreasing their utilization, while increasing the company’s revenues (look here). Were Dr Rowe’s pontifications really about improving health care for all Americans, or about justifying his previous management behavior, and perhaps supporting the price of his shares in Aetna? Why was Aetna’s public relations given the patina of an academic lecture?
– Naked Capitalism