In Health-Care Policy, as in Hollywood, Nobody Knows Anything

Over at The Atlantic, Derek Thompson addresses the problems of uncertainty and political interference in health-care reform: 

An empowered IMAC (or MedPAC), as envisioned by the administration, is an advisory board of unknown doctors and economists, with responsibilities that haven't been codified, whose job is to make recommendations we haven't thought of yet. Scoring the fiscal benefit of the council (which already exists, but in a weaker form than Obama would like) is an exercise in fantastical thinking. It is the opposite of a "scoreable offset."

But that sword cuts both ways: We shouldn't trust the CBO to accurately predict the council's cost-saving potential, but we also shouldn't eat up any promises that the panacea to our health care crisis is to de-politicize our health care policy. The reason is simple: There is no way to de-politicize our health care policy. 

Obama told the Post: "There have to be a series of modifications over the course of a series of years, and we have to take that out of politics." But health care is a multi-trillion industry with an ocean of special interests that will never leave politics. If MedPAC recommends a policy change that dramatically rations care for seniors to save costs, you can bet Congress is going to hear from the AARP. If it recommends a policy that cuts pay for doctors, then ditto the AMA. An IMAC program of quasi-oracle status would still be vulnerable to elections and future laws, so that stepping on powerful toes could ultimately get the program booted in another Congress. You can try to take public policy out of Washington, but you'll never take the Washington out of public policy.

Thompson is right up to a point: William Goldman's famous dictum about the movie business—"Nobody knows anything"—is also largely true about health-care policy. And practically, it would be extremely difficult to disentangle politics from health-care in the short run.

But, at least for those of us wary of government interference in medical care and decisions, the current political problems facing health-care do suggest a larger lesson, and perhaps a long-term strategy: If you want to de-politicize health care, the solution isn't more government, more bureaucracy, or more "independent" commissions; instead, it's, to the extent possible, to take government out of the picture. 

Last week, I discussed some of the problems with IMAC. Read Reason's archive of health-care coverage here.