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Fast Health Reform for L.A.

November 25, 2002

Comprehensive health-care reform has seemed like a perverse joke ever since the Clinton reform plan crashed in the early '90s. But a report released by the National Academy of Sciences last week, concluding that "the health-care delivery system is incapable of meeting the present, let alone the future, needs of the American public," shows how the Bush administration can begin reforms on its own now, without giving congressional infighting a chance to defeat change.

The report urges Health and Human Services Secretary Tommy G. Thompson to swiftly launch "demonstration projects" that give half a dozen counties or states freedom from rigid Medicare and Medicaid funding rules to let them "remove barriers to innovation and ... put in place incentives that will encourage redesign and sustain improvements." In return, these regions would be expected to automatically enroll some uninsured people in the pilot projects -- for example, by letting all members of a family enroll in a plan now restricted to children.

The danger is not that Thompson will ignore the academy's report. It was he, after all, who commissioned it. Rather, the danger is that he will use it as fodder to support the administration's knee-jerk cure-all for most budget problems: privatization.

The L.A. County health department's director, Dr. Thomas Garthwaite, is finishing a health-care reform plan that aims to make better use of taxpayer dollars. His proposal includes creating a paperless health-care system that tracks the cost-effectiveness of each treatment offered to patients. It would also increase the use of preventive-care experts like "intensivists," who are trained to spot signs of pneumonia and other life-threatening complications before they take hold. These measures would reduce hospital stays and help trim the $1.8 billion Americans spend annually on intensive care. Not to mention save lives.

The Bush official who would be in charge of the new projects, Medicare and Medicaid Director Tom Scully, should be falling all over himself to support the Garthwaite plan, which within its reforms includes the very changes the academy is calling for. However, Scully has been lambasting the Garthwaite plan as a "special deal" that would require him to "just write them a check and bail [Los Angeles County] out."

Scully has instead been urging the county to at least partially privatize some of its hospitals. What he doesn't say is that privatization is full of dangers because it gives health-care providers numerous incentives to "game" the system and offers few rules to prevent them from the most egregious sorts of profiteering at patients' expense.

Instead of forcing it to privatize, Scully should make L.A. County, the epicenter of the nation's health-care crisis with more than 2 million uninsured people, the administration's first demonstration project.

The Bush administration should focus not on forcing ideological solutions upon regions, but rather on enabling counties to begin practical and moderate reforms to make their health-care systems work fairly and effectively for all -- the very reforms outlined in the academy study.

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