Last Friday, I went to a presentation at the Stanford Graduate School of Business on the politics of health care reform.  Dr. Benjamin Sasse, Assistant Secretary for Planning and Evaluation at the US Department of Health and Human Services, discussed the state of the US health care system and why the latest proposals for reform fail to address its major underlying problems.  He touched on the difficulties of changing the health care system through Congress, as well as the growing costs of Medicare and the challenges of sustaining it as it currently operates.  The discussion also examined how the candidates focus on covering the uninsured, an easier problem to manage than the larger issues of controlling costs, pooling difficulties, overinsurance and overconsumption.

The presentation raised several difficult, but necessary, questions.  To what extent do powerful lobbying interests keep the status quo in place (arguing for overinsurance and coverage of expensive yet marginally effective treatments, preventing adoption of integrated electronic medical records systems), and should greater limits be placed on these influences?  Should an independent agency or sub-department assess the quality and cost effectiveness of new technologies and treatments prior to coverage by Medicare and Medicaid?  If Congress is unwilling or unable to address these issues, how will we adequately reform our health care system to remain competitive in the global economy?  Although the Genetic Information Nondiscrimination Act is designed to prevent denial of coverage based solely on genetic predisposition, how should we address denial of coverage based on preexisting conditions?

— Brenda Simon