Health Care Issue Won’t Go Away : Even Gingrich seeks to explore ways to foster quality while controlling costs

House Speaker Newt Gingrich says he wants to have congressional hearings into the fast-growing and now ubiquitous managed health care industry. It’s an unexpected proposal coming from Gingrich, the current undisputed leader of the less-government-is-better movement in Washington. But expected or not, it’s a welcome suggestion that the Speaker should pursue.

There should be congressional hearings that focus not only on managed care but on the nation’s entire health care system; such discussions have been all but abandoned since the disastrous health care reform debate last year. That debate fizzled politically but the key issues remain: Washington must face the hard choices and sometimes inherent contradictions involved in providing quality health care while controlling costs.

This is a huge challenge, and Gingrich may rue the day he told a group of cheering physicians that “you need to have some kind of government review of what are the procedures, what are the systems, what are the terms of employment, what are some of the conditions of secrecy, etc.” But even if he is stirring up a political hornets’ nest, Gingrich is right. By the end of last year, 63% of all privately insured Americans were enrolled in a managed care plan, including health maintenance organizations (HMOs), preferred provider networks and “point of service” plans. Such plans depend on a “gatekeeper” physician who typically must give referrals before a patient can see specialists. In theory, that sounds reasonable, and in good HMO plans it works. But physicians complain about medical treatments having to be justified by health care managers looking only at the bottom line. And some patients complain not only about long waits for medical appointments with the gatekeeper physician, they complain that physicians who are in one network today are in another tomorrow, making continuity of care difficult.

On some points there is no disagreement: Even the staunchest members of the American Medical Assn. acknowledge that there is good as well as bad managed care. And Congress, looking at ways to cut ballooning Medicare and Medicaid costs, knows that few can afford to pay for gold-plated, on-demand care.

Still, the struggle among doctors, hospitals and insurance companies won’t be resolved until these questions are answered: Which parts of managed care are working well, and why? And are there elements of managed care that work against the best interest of the patient, and why?

Gingrich may be loath to admit it, but he seems to be saying that when it comes to health care, the federal government does have a role to play. It may not have all the answers--but it surely can ask the right questions.