Extra Credit

Extra Credit

President Bush's economic stimulus plan, affirmative action and homeland security may top the United States' domestic agenda now, but don't be surprised to see health care reform there again before too long, says Adj. Asst. Prof. Mary Ann Chirba-Martin (Law) - and don't expect a lot to change, either.

Asst. Prof. Mary Ann Chirba-Martin (Law) Photo by Lee Pellegrini
"Issues of health care cost inflation, inadequate access and the quality of care have been major domestic concerns on a cyclical basis for at least the past four decades," said Chirba-Martin, citing recent federal statistics showing that health care consumes 14 percent of the gross domestic product and is growing at a rate three times faster than the overall economy.

"The pattern of talk and no action we've seen during that time is attributable to a variety of factors, perhaps the most significant of which is that real change would entail painful trade-offs and politically contentious choices. As a country that values a market-driven economy, we reject explicit rationing choices and often spurn centralized planning as a way to allocate limited dollars."

Health care reform has been a longstanding interest for Chirba-Martin, who holds the distinction of being the first American lawyer ever admitted to the doctoral program in health policy at the Harvard School of Public Health. Her most recent research focuses on the Employee Retirement Income Security Act's barriers to patients seeking claims against their managed care organization. She also sat on the board of directors of the Massachusetts Medical Society's Peer Review Organization.

As Chirba-Martin sees it, a host of factors make continued cost inflation "not only predictable but, sadly, inevitable," including ever-advancing technology, rising prescription drug prices and an aging population which consumes the most health care resources. Conflicts over costs and services in the third-party payment model that dominates American health care pose another problem.

National reform is unlikely to occur, she says, although US Sen. Edward Kennedy (D-Mass.) recently proposed requiring the large majority of employers to provide their workers with health benefits. "Even in a strong economy, the mere idea of an employer mandate for health benefits elicits vigorous opposition from the business community. Given the current economy, an employer mandate has virtually no chance of gaining any real momentum. Other measures aimed at mandating minimum levels of coverage are also likely to fail."

The proposed Patients' Bill of Rights, which sparked debate in Congress during the summer of 2001 but was overshadowed by the Sept. 11 attacks, might re-emerge in some form, says Chirba-Martin. Establishing a national framework for resolving patient-health plan coverage disputes, however, "will do little to address the larger problems of providing coverage for the uninsured or reigning in health care cost inflation." Nor will these concerns be ameliorated by President Bush's recent focus on tort reform as a way to assist physicians struggling with skyrocketing malpractice premiums, she says.

"What really needs to be grappled with is that health care is expensive, that we see it as it as indispensable, and that we are unwilling to make the kinds of explicit budgetary trade-offs as other nations do. What makes this task even more daunting and disheartening is that no country has yet to find a system to control costs while fulfilling every patient's need and desire for health care.

"So, while Congress may enact some incremental changes, such as prescription drug benefits for targeted populations, widespread improvement is unlikely to occur. Still, for all this, the US health care system delivers magnificent care, albeit in an erratic and phenomenally expensive manner. It's endlessly mind-boggling, often heartbreaking and infinitely fascinating."

-Sean Smith


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