Wednesday, March 19, 2008

Minnesota Health Care Transformation Task Force: The devil's not in the details, but sitting in plain sight

Posted by Craig Westover | 6:46 AM |  

Among the pressing issues facing the Minnesota Legislature this session are some very real problems with the health care system:

  • Health insurance premiums are rising, and many employers are reducing or dropping health care coverage.
  • Individuals without employer coverage are finding it difficult to obtain health insurance.
  • Increased costs and reduced reimbursements from health plans, especially those administered through Medicare and Medicaid, are squeezing physicians.
  • Large medical groups are swallowing up independent physicians and clinics.
  • Consumers are finding fewer coverage and care options, and what is available is costly.

The polite line that might follow that list is that "reasonable people can disagree on how the state should address health care issues, but it is obvious something must be done." The Governor's Health Care Transformation Task Force is the centerpiece among several public-private committees that met between legislative sessions to "do something" about health care.

Observers of the Transformation Task Force portray it as a "love fest." Even critics praise the group's efforts. I have friends on the task force, and there are folks on it I respect. But I cannot in good conscience join the chorus of "Kumbaya." There is too much at stake.

My disagreement with the Transformation Task Force recommendations is not simply my preference for free-market solutions over government-run programs, nor even that I question the potential efficacy of task force recommendations (many of which are embedded in bills being rushed through the legislative process). My objection is more basic.

The devil is not in the details of the report, he's sitting in plain sight: The task force recommendations are a giant leap toward classical corporate socialism, a "friendly fascism," but fascism nonetheless.

Some things need to be called what they are. "Fascism" is a perfectly good word when used not as an insult but as an academic description. The task force recommendations are an integration of government and private corporations that destroys the distinction and endangers individual liberty and the quality of health care. It is the task force recommendations, not the task force members, to which the "fascist" label can be justly applied.

If the task force members are to be faulted, it is for letting their good intentions blind them to the unhealthy consequences of what they propose. Their report is the result of good people succumbing to the conceit that they, or any central committee, have the knowledge and authority to manage the health care system and make life-and-death health care decisions for others.

"Successful transformation of Minnesota's health care system will require active participation and engagement from consumers, employers, health care providers, health plans and government," declares the Task Force Report. The obligations the Task Force envisions for the first four groups require fundamental behavior change; government's obligation is to "enact the necessary changes to law to implement the transformation plan." In other words, supply the muscle, the force, the coercion.

The Task Force explicitly states that its report must be taken in its totality to be effective. Implied in that attitude are certain core beliefs:

  • The state should have a vision defined by a central committee to which every Minnesotan is mobilized and committed.
  • The state is ultimately responsible for the healthy behavior of its citizens; if "encouragement" and "influence" are inadequate, "mandate" and "requirement" are necessary.
  • The individual must live for the good of the collective.
  • The state, not individual demand, should determine how much health care is needed, and the state should control the size of the health care system.
  • There is no segment of society the state cannot command into action.

Cost, quality and access to health care present problems, to be sure, but the greatest danger to Minnesota is the progressive assumption that the health of society outweighs any individual's interest in his or her behavior. That the Transformation Task Force or any group with a modicum of respect for freedom could publish a document so blatantly enslaving individual choice to the "common good" and have it be so well praised for its "good intentions" would be astonishing if it were not so frightening.

My intent here is not to discredit the 70-plus page report by killing trees; it is to point out a forest of recommendations fundamentally opposed to proven free-market principles and toxic to a robust health care system.

The Health Care Transformation Task Force was charged by the Legislature with proposing a plan to reduce Minnesota's health care expenditures 20 percent by January 2011 while increasing access to health care and improving quality. Cost reduction is the driving force of the Task Force recommendations. The Task Force report is a blueprint for the most nefarious kind of health care rationing.

Let's be clear — cost, quality and access to health care necessitate trade-offs. That is true in the managed care system we have today, in the totalitarian managed care system proposed by the Transformation Task Force, and in the purest of free-market systems.

Health care is a limited economic resource that will be rationed. The question is, "Will you manage your consumption of health care, or will someone else manage it for you?"

In a managed care system, health care is rationed for you; someone controls the supply of health care irrespective of demand; the pie is fixed and everybody more or less receives an equal share of the fixed amount. In a free-market system, you ration your own health care by making choices; choice, your slice of the pie, is always growing, albeit with some people having more choices than you and others fewer.

In a free-market system, health care is rationed by the relationship between price and the demand for service at that price, not by a central committee fixing supply and price.

The contrast of these two systems is stark. It is the difference between a managed health care system in which patients queue up for a 38-week wait for a hip replacement and an expanding market of competing Lasik surgery centers offering steadily declining prices and higher levels of quality to greater numbers of people.

The necessity to reduce costs steered the Transformation Task Force away from broad examination of macroeconomic factors like supply and demand. Instead, the task force pursued "culprit economics" — leaping to the narrow assumption that the culprits creating rising costs are physicians who provide "uneven health care below the levels we should expect for the money we are spending" and the rest of us for driving up health care costs with our "unhealthy behaviors."

Thus, changing behavior — the way doctors practice medicine and the way people live their lives — becomes the one best path to reducing health care costs, as if the laws of supply and demand could be eliminated.

It is said only two things in life are certain — death and taxes. If the Transformation Task Force recommendations are implemented, Minnesota government will have way too much control of both.

Thursday: The task force and public health.

This commentary originally appeared in the St. Paul Pioneer Press on Wednesday, March 19.

Part Two of this two-part series appeared in the St. Paul Pioneer Press on Thursday March 20, 2008.