At a time when the fate of the Affordable Care Act hangs in the balance and another attempt at repeal may be imminent, the Zetema Project is fostering robust and measured discussion on the most controversial points of healthcare reform.
Last week, the Zetema Project brought together two experts from opposite ends of the political spectrum to answer tough questions about where we are in the health reform conversation and what’s next. The entire conversation can be viewed here.
Stanford’s Lanhee Chen and VenRock’s Bob Kocher have both spent countless hours analyzing healthcare reform as Presidential advisors on health policy (Chen advised George W. Bush and Mitt Romney, Kocher worked for Obama). The points where they disagree are interesting; the points on which they agree are at times even more enlightening.
Philosophical Differences
Predictably, the two experts differ on the importance of coverage for all vs. financial priorities and level of government control. Moderator and Zetema Chair Mark Zitter challenges Chen to speak about how the right balances the ideas of minimizing government involvement while still having people be covered. “Universal coverage is a laudable goal,” says Chen. “I would say that the goal is not universally shared [on the right] …conservatives always feel like they’re playing catch-up when it comes to coverage, because they’re not willing to throw as much government resource at the problem. There is debate within the conservative movement about whether coverage is even a useful metric.”
Kocher responds: “And on the left the question is: how generous should the coverage be? …As long as insurance costs what it costs, it's going to be really really expensive to cover people.” [Video clip here]
Another key point of disagreement that falls along party lines involves Essential Health Benefits (EHBs), the list of healthcare services that plans must cover under the current system. Should the cost of EHBs be socialized? Chen argues that mandated benefits are correlated with increased premiums, and that these benefits should not be dictated at the federal level. Such programs, he says, create a dynamic where people have significantly more limited choices and also are paying more. Kocher, who is a physician, responds, “Biology is not necessarily that optional.” Kocher goes on to differentiate between EHBs that might increase utilization—thus increasing costs (such as in vitro fertilization, mental health benefits, and services for autistic individuals) and basic services, such as maternity care and cancer screenings. He believes that costs for the latter services are best spread across the population, and that doing so won’t significantly increase the utilization of care in those categories. [Video clip here]
Practical Compromises
Chen and Kocher agree that the government still has time to take action to stabilize the insurance marketplaces via risk sharing and other mechanisms and prevent the dreaded “death spiral.” They also agree that the current uncertainty about what will happen is largely to blame for skittishness on the part of health insurance companies that increasingly are concerned about the profitability of the healthcare exchanges. [Video clip here]
Regarding the mandate to buy insurance, Chen and Kocher both say that health insurance as a product is perceived as too expensive and not a good enough value for many Americans to buy it willingly. [Video clip here]
One idea raised by Chen, which gets a positive response from Kocher, is that auto-enrollment might be one effective way of getting healthy people enrolled in the exchanges. Most people wouldn’t opt out, and people tend to be happy once they’re insured. Auto-enrollment in coverage can be easier to manage than tax credits from a consumer perspective. While the Cassidy-Collins Patient Freedom Act of 2017 includes auto-enrollment, Chen notes that not all conservative policymakers may find it appealing, as it might clash with a philosophical emphasis on personal choice. [Video clip here]
Another place where Chen and Kocher agree (as again experts in the field tend to do) is on the necessity for increased cost transparency in healthcare. Chen says, “Unless we’re able to get into a scenario where the consumer has greater access to information around price and quality, it’s going to be very difficult to move the healthcare system in a sustainable direction.” [Video clip here]
The conversation between Chen and Kocher underscores the differences between the political parties but also suggests ample opportunities for bipartisan compromise on healthcare reform. As the debate rages on in Washington, the Zetema Project continues to bring together experts for measured and nuanced multi-partisan discussions on the toughest problems facing the U.S. healthcare system today.
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