For more than a decade, politicians and policy gurus have laid out various schemes to fix our nation’s inefficient health system.
But every proposed remedy or reform has fallen prey to that most implacable of all foes: the entrenched interest group.
In our political system, the most powerful force shaping health legislation and health benefits are special-interest groups. And they are legion, including everyone from insurers to drug companies to a multitude of “disease” groups.
Those who seek major health reform must first address this critical obstacle. So how do you get interest groups out of the way?
One idea now gaining ground is to create a National Health Board (NHB). Advocates say this would be like a kind of Federal Reserve Board of health. The Fed’s independence allows it to set interest rates and manage the banking system largely insulated from interest-group pressure.
So, too, the argument goes, an independent NHB would be free to organize insurance and create the best, affordable standardized health plan for all Americans.
A health reform proposal prepared for the Brookings Institution’s Hamilton Project by Victor Fuchs of Stanford University and Ezekiel Emanuel of the National Institutes of Health calls for just such a health board and is developed further in Mr. Emanuel’s recent book “Healthcare, Guaranteed.”
It’s a plausible idea for sidelining interest groups, but ultimately it’s a bad idea.
In the Fuchs-Emanuel version, all Americans would eventually receive a comprehensive health package with standardized benefits, financed through a dedicated tax. The standard package would be available through competing private health plans.
The NHB’s primary function would be to determine what is in that standard package, based on its own research of the most cost-effective treatments for illnesses.
In keeping with Federal Reserve model, the NHB would be an independent agency. Its members would be nominated by the president and confirmed by the Senate for one long (probably 10-year) term. Members’ salaries and board expenses would be covered by a special dedicated tax, not by congressional appropriations.
With such an independent board in place, advocates say, we could construct a health system free of interest-group pressure, one that will provide the most effective care to all Americans.
Sounds like a worthy goal. So why is a National Health Board a bad idea? Several reasons.
It would mean putting all our health care eggs in one basket and hoping that board members make treatment and coverage decisions that are right for every American.
And, remember, the health care industry accounts for roughly one-sixth of the entire U.S. economy.
The Fed’s ability to set interest rates certainly gives it enormous power. But imagine if the Fed could also issue rules determining the core design of one-sixth of all the products in America, from automobiles to houses.
In health care, that’s essentially what the NHB would do.
For millions of Americans, it would mean that a distant, unelected board - not their doctor or themselves - would ultimately determine what health care they could receive. These are literally life-or-death determinations.
To be sure, those with enough money could buy additional coverage or services beyond the board-determined package.
But for those without a fat wallet, the board’s decision would be final.
The board’s very independence from the people and their representatives - touted as its key benefit - is what is actually so alarming.
Some advocates respond to that concern by pointing to the track record of Britain’s National Institute for Health and Clinical Excellence, which researches effective treatments and determines which treatments will be funded by the National Health Service.
But the Institute, known by its Orwellian acronym “NICE,” cannot override Parliament, which ultimately calls the shots in the NHS. By contrast, the health board would be beyond reach of Congress.
In reality, the extraordinary power exercised by an NHB would make it less like the Fed and more like a Supreme Court of Health. And that analogy exposes the faulty premise of board advocates.
Giving the board enormous powers and supposed independence won’t depoliticize its membership and work. On the contrary, every NHB nomination would produce a political firestorm similar to those triggered by a nomination to the Supreme Court.
Yes, critical decisions over people’s health should be free of interest-group pressure.
But to vest this decision-making in a board that is beyond the jurisdiction of Congress, and thus beyond the reach of ordinary Americans, is not the right answer.
A far better approach is to move critical health decision-making from Congress and give it to families and individuals themselves.
• Stuart Butler is vice president for domestic policy issues for the Heritage Foundation (www.heritage.org).
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