Stark differences
Monday, January 12 2009
This post by Matt Yglesias almost slipped past me, but it’s worth reading. Matt points to some research from the Commonwealth Fund and the Lewin Group that suggests the Stark bill for health care reform is best in terms of increasing coverage and reducing costs. Here’s Matt:
But what’s incredibly frustrating is that a lot of people who claim to want to change public policy to expand health care coverage and better control health care costs will nonetheless fail to embrace Stark’s plan or anything similar for no real reason other than ideological posturing.
I would add that at least some of the “ideological posturing” is naked greed wrapped in half-baked rhetoric. A closer look at the CF report (pps. 30-33) shows the Stark plan’s overall cost reductions are largely achieved by reducing administrative costs, letting the government negotiate prescription drug prices, and setting Medicare-like reimbursement rates for all providers. These steps probably mean insurers, drug makers, and doctors would earn less. I’ll give you three guesses as to who will be the most vocal “ideologues” against the Stark bill, should it ever come under serious consideration.
At least one of the problems here is that we seem to have a hard time telling the difference between sincere ideological commitment and self-interest in fancy dress. But the confusion Matt points to is also a real, significant problem.
I hope you are including, as one of the three groups against the Stark bill, older patients who are on fixed incomes and on Medicare.
Decreasing payments will only increase the numbers of physicians who refuse insurance/Medicare and are on a cash-only basis. It will be increasingly difficult for older patients to find physicians who will accept the paltry payments the government offers.
You may be right about the elderly, but only insofar as that’s a secondary effect mediated by the physicians’ response. Still, I don’t think elderly people who are worried about their Medicare coverage will argue against this bill from ideology – certainly not “free market” ideology; I expect they’ll be a lot more concrete in their opposition, if any.