EDITORIAL: Piecemeal health reform that focuses only on cost won’t cut it

San Diego Union-Tribune (CA)

April 27--Health care is a profoundly important and often upsetting issue. The United States spends more per capita on health care than any other nation, yet -- with the notable exception of cancer treatments -- doesn't achieve as positive results. But changes in health care, starting with the Affordable Care Act of 2010, have proven bitterly controversial.

A big reason why is that the health care debate in this nation too often boils down into arguments over whether expanding government's role in the direct provision of medical care is a dangerous dalliance with "socialism." Given that a 2016 Journal of American Public Health study found that taxpayers already pay for 64 percent of U.S. health spending, this focus is goofy -- the horse is already out of the barn. Americans would be far better served by a reform effort that focused intensely on the cost-effectiveness of different types of care and on how other nations have achieved better results while spending less money. Scrutiny of "big data" has yielded profound insights in many fields. There's no reason to think it can't work in medicine as well, especially as medical technology improves.

Unfortunately for Californians, attempts to change health care in the Golden State in recent years haven't reflected this sort of thoughtful and constructive approach. This isn't just a knock on Senate Bill 562, which would commit California to implementing a single-payer health care system without explaining how its $400 billion annual tab would be paid for or how it could overcome immense state and federal legal obstacles. It also holds for Assembly Bill 3087, a high-profile proposal from Assemblyman Ash Kalra, D-San Jose, that would gave state regulators the final say on the cost of hospital stays, visits to medical offices and most other medical services covered by health insurance companies. The rates would be based on what the federal government pays for Medicare, a giant system with 50 million-plus enrollees.

The appeal of this approach is easy to grasp. As Robert J. Samuelson, a columnist for The Washington Post, has reported, the fact that Medicare often pays health care providers less than private insurers in reimbursements for the same medical treatments offers hope that health care costs can be contained. Charges for some treatments often seem maddening, even random.

But the criticism of AB 3087 is powerful and not easily dismissed. As health industry executives point out, the measure doesn't address the fact that hospitals sometimes believe they have no choice but to set rates for those who can pay that subsidize the care of those who can't pay or who limit what they're willing to pay -- including the Medi-Cal and Medicaid programs. Instead of a push for best practices that result in better care at a lower cost, the bill's primary intent "is to reduce payments to hospitals," as a California Hospitals Association official told The Los Angeles Times. Kalra doesn't seem to disagree, saying in the Times that he wants the health care debate to focus on the cost of care.

But this piecemeal approach is not nearly as helpful as a focus on the larger picture of why some nations spend half as much on health care as the United States yet have healthier populaces. State lawmakers who focus on the cost of health care without a similarly intense concern about the results of health care may win props for their populism, but nothing more. When it comes to fixing health care, Californians deserve a smarter, bolder and more comprehensive approach.