Monday, November 15, 2004
Book Review: Tom Miller on Herzlinger's Consumer-Driven Health Care: Implications for Providers, Payers, and Policy-makers
[Tom Miller, "Driver’s Ed For Backseat Drivers," Health Affairs, November/December 2004.]
Tom Miller, former health policy studies director at the Cato Institute, explains how it is that Market-Driven Health Care author Regina Herzlinger gets it both right and wrong in her latest book - consumer driven health care will be a major force of change, but employers and regulators need to allow consumers to run the show:
Part of the problem is that the "buyers" of most health insurance and health care are third parties (employers, insurers, and government administrators) rather than the end users (consumers) who have to live, or die, with the consequences. Regina Herzlinger is back on the road again to point this out, in Consumer-Driven Health Care. But this voluminous collection of her latest thoughts, and those of seventy-three other purveyors of consumer-driven health plans, health care, and health policy, focuses much more on how to deliver consumer-centered care than on who pays for it.
Where are the assertive, empowered, and (presumably) risk-taking consumers, and what do they really want? We don’t hear their voices directly in this volume, because Herzlinger is really selling her ideas to a different audience. But she assures us that consumers want government to provide the money to enable them to purchase the health care that they choose, instead of providing it to them in one-size-fits-all style.
As remains true of most grand reform blueprints, it’s best to set forth more limited basic objectives that help realign incentives and then get out of the way while buyers and sellers unbundle health benefits, put some of their money on the table, and learn from trial and error. New tax rules for HSAs and HRAs have already gone a long way in setting the stage by helping level the playing field for control of health care dollars. Putting more dollars at risk and up for grabs can help capture the attention of both consumers and those who aim to serve them.
Of course, the usual set of policy experts will insist on imposing protective speed bumps and higher performance standards before letting consumers actually go out on the road with not much more than a restricted learner’s permit (and plenty of airbags on board). But we should remember how we got to today’s exit ramp away from the high costs, uneven access, and quality chasms experienced with other designated drivers at the wheel. In any case, the real competition to sort out the hype and hope of consumer-driven health care will involve finding better ways for patients and medical care providers to collaborate, reengineer the delivery of care, and share responsibility for lifetime health maintenance. Real consumer-driven care can’t afford to get stuck in the slow lanes of insurance plan selection. Freeing up more cash for point-of-service decision making might finally get us out of low gear, if the backseat kibitzers will just fasten their seat belts and lean back.
[Greg Scandlen, "Choice is revolutionizing health care," The Wichita Eagle, 28 September 2004.]
[Tom Miller, "Driver’s Ed For Backseat Drivers," Health Affairs, November/December 2004.]
Tom Miller, former health policy studies director at the Cato Institute, explains how it is that Market-Driven Health Care author Regina Herzlinger gets it both right and wrong in her latest book - consumer driven health care will be a major force of change, but employers and regulators need to allow consumers to run the show:
Part of the problem is that the "buyers" of most health insurance and health care are third parties (employers, insurers, and government administrators) rather than the end users (consumers) who have to live, or die, with the consequences. Regina Herzlinger is back on the road again to point this out, in Consumer-Driven Health Care. But this voluminous collection of her latest thoughts, and those of seventy-three other purveyors of consumer-driven health plans, health care, and health policy, focuses much more on how to deliver consumer-centered care than on who pays for it.
Where are the assertive, empowered, and (presumably) risk-taking consumers, and what do they really want? We don’t hear their voices directly in this volume, because Herzlinger is really selling her ideas to a different audience. But she assures us that consumers want government to provide the money to enable them to purchase the health care that they choose, instead of providing it to them in one-size-fits-all style.
As remains true of most grand reform blueprints, it’s best to set forth more limited basic objectives that help realign incentives and then get out of the way while buyers and sellers unbundle health benefits, put some of their money on the table, and learn from trial and error. New tax rules for HSAs and HRAs have already gone a long way in setting the stage by helping level the playing field for control of health care dollars. Putting more dollars at risk and up for grabs can help capture the attention of both consumers and those who aim to serve them.
Of course, the usual set of policy experts will insist on imposing protective speed bumps and higher performance standards before letting consumers actually go out on the road with not much more than a restricted learner’s permit (and plenty of airbags on board). But we should remember how we got to today’s exit ramp away from the high costs, uneven access, and quality chasms experienced with other designated drivers at the wheel. In any case, the real competition to sort out the hype and hope of consumer-driven health care will involve finding better ways for patients and medical care providers to collaborate, reengineer the delivery of care, and share responsibility for lifetime health maintenance. Real consumer-driven care can’t afford to get stuck in the slow lanes of insurance plan selection. Freeing up more cash for point-of-service decision making might finally get us out of low gear, if the backseat kibitzers will just fasten their seat belts and lean back.
[Greg Scandlen, "Choice is revolutionizing health care," The Wichita Eagle, 28 September 2004.]
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