Thursday, August 6, 2009

Attacking Insurers - Good Politics/Bad Ethics

As you read this post, keep in mind that I direct the ethics program at a nonprofit health insurance company - Harvard Pilgrim Health Care.

The administration is feeling the heat from conservative fear mongering about health reform. The well orchestrated disruptions of Congressional town hall meetings are getting a lot of publicity. To get out of a no win defensive posture, the administration appears to have opted for an anti-insurer strategy.

This may turn out to be a good political move, since public trust of health insurers is low. And of course there's lots to criticize in our health insurance system. In the battle of sound bites, (1) turning public fears away from "ObmamaCare" onto the insurance industry and (2) pinning a "pro-insurance" label onto conservative critics, may be effective politics.

Unfortunately, the tactic also continues the process of disinformation, which has resulted in an extraordinarily low level of public understanding of the health system. Modern health systems need active management. This is true for the Canadian single payer system, the British National Health Service, and our own hodge podge of public and private payers. The driving forces for our out of control health expenditures are the way we provide care as clinicians and the expectations/demands we have as patients.

Health insurers are in the middle of our profligate provider system and our clueless consumer system. In the 1980s and 1990s U.S. public policy asked insurers to alter clinical practice and educate the insured population. There was tremendous pushback against insurer led managed care and insurers have largely backed off from that effort.

Even if a public program is part of what emerges from the reform process, it will have to decide what will and will not be covered, how to apply comparative effectiveness findings, and when marginally beneficial care is too expensive to include. And if accountable medical organizations are asked to take over insurance functions by being given a budgets to care for populations, they will have to carry out these same activities.

As I said in a recent post, my candidate for the demon the administration needs is conservative rhetoric itself. If the conservative attackers mean what they say, the logical extension of their sound bites is that Medicare should be abolished, since it is a government run, single payer program.

The administration isn't proposing a single payer insurance plan. So whatever comes out of the health reform process we will still have an insurance system. Demonizing the programs we'll be turning to for thoughtful guidance to providers and the public may make short term political sense, but it isn't a coherent long term strategy!

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