COVERITLIVE.COM

12:16

Fred Barbash - moderator - We are getting ready to start the live chat - please stay tuned.

12:34

Fred Barbash-Moderator - Welcome readers and welcome Henry Aaron, who needs no introduction to those who have followed policy in the fields in which he specializes. A noted health care expert, Henry Aaron focuses on the reform of health care financing; public systems such as Medicare and Medicaid; Social Security; and tax and budget policy. He is one of the nation's most distinguished and prominent scholars on these topics.

Let me begin by asking Henry whether he thinks the heavy focus on the "public option" is indeed the right focus at this stage of the healthcare debate.

12:35

Henry Aaron - I don't think so. First, we don't yet know what the option would look like. Past experience suggests that Congress will not permit a federal program to have a major adverse impact on private competitors; hence, pressure is not likely to be excessive. More importantly, it is a red flag, which I suspect Democrats will give up in order to secure a measure of bi-partisan support. The key issue is going to be how to pay for the cost of extending coverage.

12:36

[Comment From Rolinda]
What are the realistic prospects for health care reform as you see them? Many people say that it has to be done before we get into an election year, or it won’t happen. Do you agree?

12:36

Henry Aaron - Less than 50/50, but better than ever before. Many people say that it has to be done before we get into an election year, or it won’t happen. Do you agree? It won’t happen in an election year, but depending on how the debate goes, health could become a major issue in the 2010 mid-term elections, nationalizing what is usually a collection of local campaigns, and that, in turn, could result in another round of reform in 2011.

12:36

[Comment From Erin]
Can we change the culture of health care in this country? Wouldn’t an emphasis on wellness and prevention be a better and a more cost-effective strategy than treating illness once it occurs? Or is that just a pipe dream?

12:37

Henry Aaron - No. wellness and preventive interventions can be very good for our health, but repeated studies have shown that they do not, on balance save money. There are a few exceptions (vaccinations). The central problem is that death comes to us all; preventing early deaths does not avoid eventual and often larger outlays.

12:37

[Comment From Shawn]
Why is health care in the US so expensive?

12:38

Henry Aaron - Tons of reasons: complex administration, high physician pay, a huge number of tests (notably, radiology), aggressive end-of-life treatment, and on and on. The large number of reasons means that fixing one problem won’t materially bring down the growth of spending. One has to do everything! And that is formidably difficult.

12:39

[Comment From Sally]
Why do you think odds of passing health care reform are so low?

12:41

Henry Aaron - We are talking about a $2.5 trillion industry; that means many and extremely well-funded groups sensitive to possible losses of income or autonomy. The added costs for subsidies for those who cannot otherwise afford coverage mean that the government has to find ways to pay for those added outlays--and that means higher taxes or cuts on other spending. Most importantly, the term 'health industry' encompasses a bewildering variety of activities, which makes any far reaching reform enormously complicated.

12:41

[Comment From Christopher Grau]
how could you deal with high physician pay without drastically reducing the number of people willing to go through a great deal of expensive schooling?

12:43

Henry Aaron - Right now, U.S. doctors earn more relative to average incomes than do physicians in any other nation. There may be some room here for real economies. But cutting doctors' incomes is not the key to slowing spending growth. As the quip goes, the most costly medical instrument is the doctors pen--his or her capacity to order costly procedures. The advent of better information on what works and what doesn't can help improve the efficiency of those decision.

12:43

[Comment From Taylor]
Do you believe that the private sector will be able to compete with the public?

12:45

Henry Aaron - If there is a public option in the end (which I doubt) the answer will, in my view, be 'yes.' Congress is not going to tolerate a situation in which a new public plan drives private vendors out of business. Whether it should or not is another matter. That means that a public option is likely to be relatively anodyne.

12:45

[Comment From Frank]
The polling on this issue is interesting. Everyone thinks their own health care coverage is sub-par, but in the context of reform they don't want to lose it. What is your take on public opinion? And how does that affect what Congress will do?

12:47

Henry Aaron - Actually, I don't think this is what polling does show. Most people think their last visit to a physician or hospitalization went well. They also think the system as a whole needs reform. Interestingly, the evidence is that people do not receive all the care that is recommended for their particular condition--in fact not much more than half of recommended care. The biggest problem for Congress is that people think they are paying too much out-of-pocket for health care, when, in fact, they are paying only about 15 cents on the dollar. The real problem is total cost, of which few people are aware.

12:48

[Comment From Clif]
Are there any viable models out there to replace the distorted incenitves in our current fee-for-service or traditional capitation models?

12:49

Henry Aaron - All reimbursement systems have flaws. But fee-for-service is just not working well in a medical world where treatments for complex conditions require coordination of the services of many providers. There is increasing evidence--and consensus among experts--that the right model is that of a team of providers paid for the package of services that people receive for the conditions from which they suffer. Mayo, Kaiser, Geisinger are all systems that seem to work much better than does ordinary fee for service.

12:50

[Comment From Nick]
President Obama has been vague whenever he speaks about Comparative Effectiveness Research. Insurance and Pharmaceutical companies are watching this issue closely as it will effect them the most. What kind of Comparative Effectiveness Research do you believe will be implemented during this reform, if any? What specifically will the criteria be?

Page 1 Next >