Better Politics on Health Care

The leading presidential candidates have outlined basic plans of greatly varying cost to heal the nation’s ailing health care system. While Democrats propose more government spending and Republicans champion market-based remedies, both sides have ignored the structural and regulatory reforms that will be key to fixing health care’s underlying problems. Candidates are focusing so narrowly on the controversial health care spending issue that they give short shrift to moderate, politically viable solutions. On the whole, fixing structural problems in health care would lower, not raise, health care costs, which have been rising at three times the rate of inflation.

The key structural problem, liberal and conservative health care experts agree, is the lack of coherent, transparent systems for monitoring and improving health care quality. A recent report from the federal Institute of Medicine showed that medical errors result in millions of unnecessary injuries and hospitalizations every year, and last month a report from the National Academy of Sciences pegged the annual toll of avoidable deaths at up to 98,000.

Quality monitoring in the United States is generally conducted by private trade groups funded by the very institutions they regulate. These organizations have so far resisted government scrutiny, but candidates should call for more oversight. For example, last month the Chicago-based group that regulates hospitals, the Joint Commission on Accreditation of Health Care Organizations, announced that it plans to beef up its quality monitoring standards by beginning unannounced, random hospital inspections this month. Candidates should call upon the secretive accreditation group to at least disclose which hospital practices it will be investigating and which medical quality standards it will be using.

Some candidates are also playing to the crowd with proposals to allow more lawsuits against HMOs; they need to temper those proposals. For instance, doctors and hospitals are far more likely to report medical errors if granted some of the same legal immunities now afforded to pilots and air traffic controllers.

New or expanded federal health programs need a solid foundation for ensuring that patients get quality health care. Everyone involved--employers seeking quality and value, patients struggling to get decent care, nurses grappling with staffing shortages--should insist on better plans than any of the candidates has offered so far.