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Is This the Health Care Revolution That We Need?

MANAGED CARE February 2005. © MediMedia USA
Editor's Memo

Is This the Health Care Revolution That We Need?

John A. Marcille
MANAGED CARE February 2005. ©MediMedia USA

John A. Marcille

It is unusual, although not unprecedented, for Managed Care to devote a cover story to a political figure. A fair amount of what comes from politicians is nothing more than hot air, as we all know. Certainly nothing that would even survive "peer review lite."

Newt Gingrich, however, is a force to reckon with.

Let me say up front that we are not endorsing his point of view. Nor are we rejecting it. We are reporting it, because even though he has been out of Congress for a decade, this former speaker of the house remains highly influential. A few weeks ago, the New York Times ran a prominently placed profile of him titled "Health Care's Unlikely Surgeon."

He will be a keynote speaker at the annual National Managed Health Care Congress in Washington, D.C. in early March. And there have been recent rumblings about Gingrich for president in 2008.

Contributing Editor Martin Sipkoff and I talked with Gingrich in late February in his Washington office.Martin's article has plenty of food for thought.

Newt Gingrich is probably further to the right than many of our readers (many others will agree with many if not all of his statements), but I believe that most can agree with his observations on the paternalism of the existing system, the unaligned incentives of third-party payment.

Frankly, one of the most appealing aspects of the Gingrich vision, from one societal point of view, is his insistence that everyone "participate in the insurance system," as he says in his most recent book. Poor people would get tax credits and/or Medicaid vouchers. Everyone else would have to buy insurance. If employer plans survive, OK. If not, buy it yourself. Economists tell us that when our employer buys insurance for us, he is using money that would go into our paycheck anyway, so what's the big deal?

Well, the big deal may be economies of scale. Believe me, it costs more for me to insure my auto directly with the insurer than it would cost my employer to insure the same car as part of a fleet. Bulk purchasing. If you want to control health care costs, yet get the third party out of the picture, you need to preserve this aspect of the system.

Gingrich does envision large risk pools being established for poor people, but even so, I see costs exploding if we go to a predominantly individual market, with the result that people become underinsured.

We must be clear that Gingrich goes very far in his thinking. He requires consumers to become very engaged in their health — exercise, eat properly, take proper preventive measures — things that I have not seen uppermost in the so-called "consumer-driven" plans of today. Clearly, it would be great for individuals to behave more responsibly, and yet, no matter what the economic system, many of them will not.

Tough, says Gingrich. Part of me applauds that, and part of me is appalled.

What we do need is creative thinking. It used to be that great men were credited for the major changes in history. Nowadays, we see social currents and even environmental change as major factors. But in the short run, our ideas are all we can work with.

And how can you ignore a man who says "First you save lives, then you save money"?

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