Does Health Care Need Its Own Iraq Study Group?

Let’s get out of the trenches and pull out a wide-angle lens on health care in this country.  The U.S. current efforts in health care reform do not exist in a vacuum.  Countries around the world – including every industrialized nation except us – have developed their own unique system for providing quality, affordable health care for all.  But we are as woefully ignorant of the facts on the ground in those countries as we are the daily politics of Burkina Faso.  And whatever we think we know, divide that by 3 and you’ll get the amount of knowledge that percolates into our debates in Congress.  If we’re really going to strategize about what we need to do to not only fix health care, but create a sustainable system that learns from best practices, health care’s going to need its own Iraq Study Group.

To be perfectly clear, I’m not suggesting the current momentum towards a real health care bill should slow down one iota, or to give any wacky ideas to the Senate.  We’re already seeing enough of their stupid Senate tricks in procedural protestations of not having 60 votes (though on October 15, that magic number is 51.  Just sayin’.  Probably should remember that, Baucus, Kennedy, Reid and Dodd) – we don’t need them to apply the breaks for the sake of their favorite “blue ribbon commission” tactic.  Normally, that’s code for “Let’s do absolutely nothing,” and because of skyrocketing costs and eventual system-wide insolvency, to say nothing of the millions of Americans uninsured and underinsured, we can’t afford to wait.

But this idea – which was suggested to me this weekend by health care activist Pearl Korn – will still be good when the political sturm and drang has died down.  In the still touch-and-go event that we manage to pass the first comprehensive health care reform program for citizens under 65 in this country, that’s not the end of the process.  It’s the beginning of a whole new set of questions.  These questions are not unique to us.  Japan has issues with physician compensation and reducing the incentives that drive doctors to prescribe more care, not necessarily better care.  Switzerland constantly wrestles with its high health care costs, which seem exorbitant compared to the rest of Europe, but are small potatoes compared to our wasteful ways.  France has managed to extend some form of comprehensive coverage to its citizens nearly twice over, and has a model of emergency care that yields even better results than ours.  There are lessons to be learned here.  ‘Til now, academics, policy wonks, and the occasional uppity blogger have been the only ones pushing this information out there – meaning it seldom makes it to the halls of power.

So the idea is to create an Independent Health Reform Commission, similar to the Iraq Study Group.  That means creating a body of experts with credibility and respect.  That also means keeping an eye on bipartisanship.  People may think that economists can offer independent analysis, but try reading articles by Paul Krugman and John Goodman back to back.  Balance opposing ideological viewpoints with a common intellectual curiosity.  And, of course, find a former high-ranking politician on each side who can navigate the politics of being an ad hoc commission with a Congressional portfolio.  (Think former Senators Tom Daschle and Bob Dole in the James Baker/Lee Hamilton roles from the ISG).  The Commission would be charged specifically with looking at the facts on the ground for the 10 major industrialized countries with a national health care program and developing recommendations best on their best practices.  These recommendations would seek to refine our own efforts at expanding access, controlling costs and improving quality.

No one would seriously suggest that we take the health care system of Taiwan and drop it lock, stock and barrel into the middle of a floor vote in the Senate.  But the debate we've seen in Congress, be it on SCHIP, on changes to Medicare, or on any comprehensive reform, always treat health care as if the U.S. invented it and we know everything there is to know about it.  We don’t, nor do we need to close our eyes to best practices around the world.  More to the point, as our current health care debate shows us, we’re going to talk about other countries whether we know anything about them or not – indeed, those who know the least about health care in Canada or Britain are often the most likely to talk about them.  Now remember the debate over the Iraq War in the hyper-partisan years between 2004-2006.  Not only was there no clear path forward other than the increasingly useless refrain of “stay the course,” there was no common ground to even discuss the alternatives.  If nothing else the ISG injected a sense of grounded realism into the debate, and the very existence of the research they conducted and their specific policy recommendations fundamentally altered our understanding of what was happening and what was possible.

Whether we get real reform out of Washington this year, we need that same grounding in realism and elevation of the level of debate in health care.  The decisions that follow the President’s signature will be just as important as those which preceded it.

(Photo credit:  Steve Rhodes on Flickr.)