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How Jon and Kate Could Kill Health Reform

PH2009062603479.jpgLiza Mundy had an op-ed over the weekend arguing that Jon and Kate's marriage could have been saved if their health insurance had covered in vitro fertilization, which carries a lower risk of multiple births. Jon and Kate "Plus 3," she says, might have had a better shot at happiness.

Maybe. But putting Jon and Kate aside, Mundy is getting to something that's really going to bedevil health reform as it nears the finish line: the aggressive jockeying for the government to mandate that every legitimate, and some illegitimate, treatments are covered in the minimum benefit package. Does acupuncture get the nod? Oxygen treatments? Lumbar surgeries?

This is why some reformers -- Max Baucus among them -- have advocated the formation of an expert-staffed Federal Health Board that would be empowered by the legislature to make these decisions. It's a smart attempt to solve a tough collective action problem. If some members of Congress are going to demand that their hometown device manufacturer gets taken care of in return for their vote, then all members will have the incentive to do the same. The only way to block that scenario -- a scenario in which the final bill becomes groaningly expensive and unwieldy -- is for all members of Congress to give up their right to that sort of benefit micromanaging and instead vest that power in the hands of a semi-independent agency.

Photo credit: AP Photo/TLC, Mark Arbeit.

By Ezra Klein  |  June 29, 2009; 10:09 AM ET
Categories:  Health Reform  
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I don't for a second believe that the Congress (either/both houses) will give up their right to demand and get changes in coverage in return for votes. So, a vote for Climate Change will be exchanged for a vote on IVF. Its crazy, but that is how the game has evolved, and that's why strange things appear in bills the night before the final vote.

This is going to be especially true on any health matters that concide with the ideological battles on 'family values'. The pressure groups that would battle (for and against) on unrestricted fertilization to save the "babies" versus IVF versus no fertility assistance for those under 21 years of age, etc. will be there with megaphones, money, organized emails/phone-ins, Fox News hysteria about the end of freedom,

Anything authorized/prohibited or paid for by Fed. law will be partisanized, subject to lobbying/financial support, and the subject of trade-off votes. So, some will say 'take it out of politics' by having a board of expert citizens, and then we will SCOTUS-level fights about confirming the board members, followed by "exceptions" that override the boards judgement.

Here's a broad (and undocumentable) assertion that is true: There is no way to take politics out of these decisions. Maybe there should be, but wishing for a pony for every child is just as likely to be productive.

Posted by: JimPortlandOR | June 29, 2009 10:47 AM | Report abuse

The only way that benefits can be managed is by an independent board. A good model might be the Medicare Coverage and Evidence Development Advisory Committee (MedCAC) or a board like MedPAC, both of which have at least some track record for making some tough recommendations. Both MedCAC and MedPAC have been "lobbied" by industry and Congressional members, but their recommendations have generally resisted that lobbying. I predict that as Jim points out, Congressional members will find it difficult to give up their right to put pressure on these decisions.

Posted by: LindaB1 | June 29, 2009 11:09 AM | Report abuse

I've seen very little commentary on the issue of WHAT, as opposed to WHO, would be covered under any type of health insurance reform. It would seem like CBO would have to have some concept about what the coverage would be in order to produce cost estimates, but I rarely see it mentioned. This also comes into play with the concept of 'mandating' insurance coverage - what would be defined as insurance, would catastrophic coverage be enough or would it have to cover routine and preventative services? After spending two decsdes dealing with 'angels on the head of a pin' question in adminstering federal programs which are quite simple in comparison to health care, I can testify that devil in indeed in the details.

Posted by: exgovgirl | June 29, 2009 11:15 AM | Report abuse

But one key reason why health insurance is so expensive in high mandate states is precisely because of these sorts of special interest mandates. Further, one key reason why the public plan as pronounced in Kennedy-Dodd will have such an advantage over private plans is precisely because they can avoid the burdensome state-by-state mandates. So shouldn't Mr. Klein also be arguing against all state-specific mandates, and agree with Senator McCain's plan from the '08 campaign that citizens should be able to shop for health insurance across state lines?

Posted by: Dellis2 | June 29, 2009 3:26 PM | Report abuse

That op-ed was horrific. The whole concept of government mandating that insurance policies cover specific treatments is a factor in the lack of affordable coverage.

The unspoken issue here is why we would even allow a treatment that results in extreme multiple births. Reduction would have been the sensible alternative here.

Posted by: staticvars | June 30, 2009 1:41 PM | Report abuse

staticvars is 100% correct.

I'd love to see a list of what is MANDATED to be covered across the country. You want to see waste? Many states require infertility to be covered (which by the way does NOT decrease it INCREASES the risks of multiple births as well as low birth weights that add millions per case to the costs). But the infertility doctors lobbied well enough to have most states cover them. Now their clinics are popping up all over the place. Listen, I feel badly for people that can't have kids, but at some point we have to consider what is medically necessary and what is not and I'm sorry that's NOT medically necessary.

Also in NJ they wanted to cover gambling addiction treatment as well as baby formula.

Most states have an average of 45-50 MANDATES or requirements for coverage. You want to reduce costs, REDUCE MANDATES.

Posted by: visionbrkr | July 1, 2009 11:30 AM | Report abuse

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