Fighting Over The Health Care Pie

Published March 31, 2009

Last week President Barack Obama brought together most of the nation’s health care establishment to hold hands and sing Kumbaya at the White House. The purpose of the meeting was to start divvying up the nation’s health care pie among the “stakeholders”—hospitals, nurses, doctors, insurance companies, pharmaceutical companies, employers, unions, and so on.

Notably absent were the advocates of greater consumer empowerment, even though consumer-directed health care is the only health reform that is actually working as promised. Unfortunately, consumers aren’t well-organized. They don’t have lobbyists or PAC money to bribe politicians with, so who cares what they think?

Consumers, the conventional thinking holds, should be content because all these other groups are “giving them” health care. Never mind that all the money comes from consumers in the first place and is supposed to be spent on their behalf. We should just accept what the stakeholders choose to do with our money and stop complaining.

The politicians will decide who gets how big a slice of pie. And that’s when things get interesting, as every stakeholder works hard to maximize its slice. They start snarling and growling at each other like a pack of hungry dogs.

The country’s two biggest unions (AFSCME and SEIU) last week dropped out of a coalition of interest groups because the coalition would not agree to support a public option in addition to the private health plans Obama wants to put into his Health Insurance Exchange.

The other coalition members, notably America’s Health Insurance Plans and some business groups, think that would undermine private coverage by using price controls and subsidies to make the public plan look like a better deal when it really isn’t. This is a life-and-death issue for the private plans.

Similarly, the American Medical Association has put a lot of money into an advertising campaign intended to alarm people about the plight of the uninsured. But now it’s getting worried the administration’s combination of Medicare cuts and pay-for-performance proposals will end up requiring doctors to practice medicine according to federal government dictates.

Several business groups were willing to support mandating individual workers to have health insurance, as long as employers weren’t required to pay for it. But that tradeoff was never realistic, and the business groups are beginning to realize they will be presented with the bill for the politicians’ plan.

It is dawning on people across the political spectrum that it is inconsistent to argue that America spends too much on health care and then propose spending an additional trillion dollars to fix the system.

This is all just the beginning. Once the politicians start deciding who gets paid how much for doing what, the infighting will intensify. Why should physical therapists get paid if chiropractors aren’t? Why pay for dieticians but not nutritionists? And what about nurse midwives, psychiatric social workers, and plastic surgeons? How many doses of Viagra is a month’s supply? And how can you pay for that without also paying for birth control pills?

Each interest group will see the answers to these questions as a matter of professional life or death, and they’ll all hire lobbyists and donate to political campaigns to air their concerns. Not a penny of that money will go to patient care, but pleasing politicians will be far more important than pleasing patients.

And so it goes with health reform in the twenty-first century, and this is only in the first two months of the new administration. We’re just getting warmed up.

Greg Scandlen ([email protected]) is president of Consumers for Health Care Choices at The Heartland Institute.