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1983: When (Legislative) Giants Walked Among Us

The Great Communicator in action

The Great Communicator in action

The inability of our current Congressional representatives to do anything at all about health care — access or costs — is highlighted by contrasting today’s bumbling Congress with some legendary Congresses of yesteryear.

“Yesteryear” meaning, in this case, 1983.

Michael Millenson has a post at the Health Care Blog describing the wonderful things that happened when those legendary statesmen of yore (i.e., first Reagan administration) wielded the power of government for the sake of helping the nation.  Back when the Dukes of Hazzard was must-see TV, Congress managed to cut skyrocketing Medicare costs by passing the DRG-based prospective payment system that shifted financial risk to hospitals and led them to provide quality care for less money.

Millenson’s point: nothing like this is likely to happen today because of ideological zealotry and slavish devotion to special interests.

The Reagan administration understood that being for “small government” as a regulator did not mean abandoning efforts to make sure taxpayers got their money’s worth from government-as-purchaser. Prospective payment was the strategy of a prudent purchaser committed to encouraging efficiency. Hospitals were put at financial risk: those who could efficiently deliver care for less than the average price made money;  inefficient hospitals lost money. Within that context, DRGs represented deregulation.

That confidence in appropriate use of government power helped the administration withstand a firestorm of criticism when DRGs actually went into effect. Although the term “death panels” was not used, the same idea quickly surfaced. The president of the American Medical Association, for example, declared that doctors were “not going to be allowed to practice medicine…based on their own judgment” and that “rationing of health care” had begun. Other critics spoke of patients discharged “quicker and sicker” to a “no-care zone.”

Sometimes I long for the good ol’ days, back before we became a nation of pygmies.

Yeeee-haaaaaah!

Yeeee-haaaaaah!

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