Uwe E. Reinhardt
is the James Madison Professor of Political Economy at Princeton University and a member of the boards of directors of Amerigroup
I recently interviewed Reinhardt to get his thoughts on health care’s impact on our economy. This is part two of our interview; if you missed it, go back and read part one.
Andy Louis-Charles: What is the biggest idea in health care today?
Uwe E. Reinhardt: The biggest idea is actually an old one: Instead of paying piece-rate (fee-for-service) for health care, which induces providers to package many pieces (services) into the treatment of patients, there should be one payment for all of the services required, according to good clinical science, in the treatment of given illnesses. Although it is probably not politically correct to say anything good about government in this country, I will tell only Motley Fool, Inc., that the federal government actually has led in this regard. In the 1970s, it experimented with case rate payments for Medicare patients receiving hospital care. These payments are now known as DRGs, after Diagnosis-related Groupings. But the idea should be broadened to far more treatments in and out of the hospital.
Louis-Charles: What should citizens know about their U.S. health care system?
Reinhardt: Citizens should know that, on average, the health care they receive in this country is as good as that received by citizens elsewhere in the industrialized world, and at its best it is arguably the best care in the world. On the other hand, the way we pay for our health care -- ... how we structure health insurance -- is probably the worst. If anyone in health reform debates abroad suggests that a particular proposed reform will make their system like the U.S. system, that always is the kiss of death of such a proposal.
Louis-Charles: Have the large, for-profit health care benefits companies like UnitedHealth Group
Reinhardt: So far they have covered roughly two thirds of the American population and accounted for about one third of total health spending. Whether they have done this better than a public program could have can be debated. I do not view them as particularly innovative -- not as innovative as, say, is Medicare. But overall they have served the American people to the latter's satisfaction. At the same time, the complexity (the operative word might be chaos) they seem to love has driven up substantially the administrative burden on the U.S. health system, and it has also stood in the way of the smart, systemwide adoption of health information technology. Other countries seem ahead of us in terms of implementation, even though Americans invent much of the hardware and software used for that purpose.
Louis-Charles: Are retail in-store clinics a good trend in health care (i.e., CVS Caremark's
Reinhardt: I think these clinics are a useful innovation. They are convenient, probably offer better hours, and they also provide badly needed competition for a health system that has always found it hard to provide 24/7 coverage at affordable prices. One should expect traditional providers -- mainly doctors -- to harrumph over "poor quality," but I would argue the opposite. Large companies have a reputation to protect. Like McDonald's, they cannot afford to offer shoddy care.
Louis-Charles: Your thoughts on a single-payer system? Should health care be treated any different than police, fire, or postal services?
Reinhardt: Many countries with single-payer systems (Canada, Taiwan, etc.) ask that question. Those countries do view health care like fire protection and elementary and secondary education, and they structure their health system accordingly. We are rather an exception, viewing health care as basically a private-consumption good, but we don't quite believe that either -- hence the coexistence of unbridled kindness and unbridled callousness in our health system. We do not have our head straight on this issue. Other countries have.