By Guy Boulton
Rep. Paul Ryan, the most prominent Republican on health policy, sums up the importance of remaking our health care system this way:
"If you get health care right, so many other problems that we have in this country, our economy and our fiscal situation improve themselves."
The Janesville Republican spoke Friday at a panel discussion on health policy held by the Milwaukee Press Club. Much of the discussion focused on how to "get health care right."
The question often centers on the most effective ways to slow the rise in health care spending and expand coverage to people who can't afford health insurance: The increased regulation of the federal health care reform law or proposals that would rely on the marketplace.
A third approach might involve some mix of the two.
"I really believe there are seeds for a bipartisan approach," Ryan said.
That might seem quixotic. On Friday, some of the topics discussed, such as the need for some insurance regulation, suggested the potential could exist for compromise in the contentious and complex health care debate.
"We can have a system in this country where everyone has health insurance, regardless of their income, regardless of their health status," Ryan said. "That's achievable. We spend more money on health care than any other country."
Ryan, an opponent of the health care law passed in 2010, has been at the center of the debate, and he could have a key role in shaping health policy if the Republicans win the White House in November.
What needs be done to slow the rise in health care spending was outlined by John Toussaint, a physician and former chief executive of ThedaCare. The health system based in the Fox Valley has drawn national attention for using lessons from manufacturers to eliminate waste in how health care is delivered.
Toussaint, author of two books on health care, said:
* Information on health care quality and cost must be publicly available.
* The way hospitals, doctors and others are paid must change to reward those who provide the best care at the lowest cost.
* Hospitals and doctors must redesign how care is delivered to eliminate waste and other inefficiencies.
"All three of these have to be done at the same time," Toussaint said.
Federal health care reform contains provisions to move away from the so-called fee-for-service system in which doctors and hospitals are paid based on the volume of services they provide rather than whether the care helps patients.
"Fee-for-service payments absolutely have to go away," Toussaint said. "That's one of the fundamental flaws of where we are today."
He noted that no one knows whether the new models under federal health care reform will work.
"These are all experiments that have yet to be tested," he said, "and certainly have yet to be proven."
Not perfect, but a start
Susan Giaimo, a visiting assistant professor of political science at Marquette University and author of "Markets and Medicine: The Politics of Health Care Reform in Britain, Germany, and the United States," noted that provisions in federal health care reform encourage such experimentation.
"It's not perfect, but it's a start," Giaimo said of the law. "It does a lot of things to bring costs down."
Giaimo also criticized Ryan's proposals to rein in Medicare spending.
The most recent proposal - made with Sen. Ron Wyden (D-Ore.) - would provide a payment that could be used to buy a private health plan or to remain in traditional Medicare.
The idea is to encourage consumers and health care providers to be more conscious of costs.
The payments would increase at a rate slower than the historical growth in Medicare spending. Critics contend it would shift costs to people covered by Medicare over time.
Critics also say there is little evidence that private Medicare health plans have slowed the rise in costs. They contend people would be forced to shop for insurance in a confusing marketplace.
In some areas, Ryan and Giaimo showed general agreement - a rarity in what's become an increasingly polarized debate.http://paulryan.house.gov/News/DocumentSingle.aspx?DocumentID=283221
Ryan noted the proposal he crafted with Wyden would fully subsidize care for people with low incomes. He also said the market would require regulation.
"There is a way to do this," he said. "No one is suggesting laissez-faire."
Giaimo and Ryan also may be representative of the divide on health care reform.
During the debate on health care reform, someone noted that some people don't trust health insurance companies while other people don't trust government.
Giaimo supports more regulation of the health care market, particularly for health insurers. Ryan puts more faith in the marketplace and is wary of a centralized approached to revamping the health care system.
"When you put all the power in Washington, it is politicized," Ryan said. "It is interest-group driven. It is not quality driven. It is not done in the interests of patients.
"It is done in the interests of whoever has the power and whoever has the clout. And that's not the way to run government, let alone the health care system."