Efficient Health Care: How to Make it Happen

A 1997 survey found that a majority of Americans had an unfavorable view of managed care.  Two years later, more than a third of Americans polled complained that their quality of their care had declined over the previous five years.

Many people had been put in situations they found uncomfortable or even scary, but the sum of their anecdotes never added up to compelling evidence that the quality of care was declining.

Public debates that ultimately allowed several major Blue Cross plans to abandon their non-profit status doubtless fed a public perception that insurers were more interested in making money than in providing patients with needed services.

Politicians responded.  Congress enacted The Newborns’ and Mothers’ Health Protection Act of 1996 which required that maternity coverage guarantee at least a 48-hour inpatient hospital stay for normal births and a 96-hour stay for C-sections, which immediately grew in popularity.

States enacted hundreds of laws mandating specific coverage to guarantee access to specific services like infertility aid or bone marrow transplants.  More than a dozen states required the option of an inpatient stay after a mastectomy.

And costs again began to rise much more quickly than broader inflation.

There’s a continuing tension between poll results showing that a majority of Americans are willing to accept some limits on coverage or choice of providers in return for paying less and continuing complaints from individuals who believe they’re being unfairly denied care they and their providers believe appropriate.

A lot has happened since the Nixon years.  But the gulf between the public – which fears that it is already being denied needed care – and the experts – who think our cost problems are fed by the acceleration of unneeded care, which was already substantial when this debate began – remains quite wide and was demonstrated once again earlier this year during the Congressional debate over evidence-based medicine which was seen as another attempt to “ration” needed care.

Unless the current debate can shrink this area of dissonance, real progress will be very difficult.

Jim Jaffe is a former congressional staffer and current contributor to HuffingtonPost.com and Centeredpolitics.com.

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