Smart Jon Gruber Interview on Coverage Expansion Before Cost Control
Connector Board member and MIT economist Jon Gruber was interviewed today by Washington Post blogger Ezra Klein.
In addition to the mention of Health Care For All, the interview shines lots of lights on how expanding coverage is the first step to getting serious about cost control:
Klein: One of the peculiarities of the [national health reform] bill is that it actually “does” coverage. If the bill succeeds, then pretty much every American will have insurance. But it really only starts cost control. Coverage is more of an event. Cost control seems more like a process.
Gruber: That’s exactly right. We know what happens if we don’t do this. The science of coverage is ahead of the science of cost control. We know how to do coverage. But we don’t know how to bend the curve with research yet. Are we going to hold 46 million uninsured Americans hostage to figuring that out?
My view is, even if the bill did no cost control it would be an incredible thing for this country. But politically, it sets the stage for cost control in two senses. First, it puts in place all the things we can do now. It does comparative effectiveness and pilots and all the rest. But second, once you get coverage off the table, the conversation gets more focused on cost control.
That’s also because the people who mainly care about coverage now have something they need to protect from health-care costs, right? If costs aren’t controlled, you can’t keep the coverage.
The same thing happened in Massachusetts. We passed our bill. The lobbying group Health Care for All was incredibly important in that. But they were primarily about coverage. But then they realized that they would lose all this coverage they’d gained if it didn’t control costs. So they got behind real cost-control measures. A global budget, even.
People say you can’t do coverage without cost control. I think it’s the opposite. You can’t do cost control before coverage. We would do a huge amount for the cause of cost control just by covering people.
January 6th, 2010 at 6:59 pm
The last sentence of this article is probably the most important.
Once we have coverage we can start controlling costs and the first and most effective way would be to prohibit pharmaceutical companies from dealing direct with the public (i.e.via TV commercials). These companies spend billions of dollars each year on TV advertising and we are the ONLY country in the civilized world that allows such advertising. How do they pay for this enormous cost? Obviously by building it into the cost of their products.
Pharmaceutical companies should only be allowed to “sell” their products to doctors.