High costs, barriers to access, complexity beyond belief and frustration among many health professionals –that’s how Theodore Marmor, PhD, describes our current healthcare system.
A Yale political scientist, Marmor is considered a scholar of the modern welfare state, with special emphasis on health and pension issues. At Yale, he’s an emeritus professor of public policy and management.
On Thursday night he appears in Portland to offer his insights about Medicare and the Affordable Care Act.
His talk, co-sponsored by the City Club of Portland, gets underway at 7 p.m. in the Collaborative Life Sciences Building on the OHSU campus on the South Waterfront Central District.
Marmor’s writing explains how our healthcare system has evolved – starting with the passage of Medicare – when that program was initially intended to turn into an insurance system for everyone – not just the elderly.
His research also looks at the strategic assumptions built into the Affordable Care Act. “In short, why did get the ACA we did, and what does that mean for any strategy of reform for 2015 and beyond. That strategy has to be consistent with the political realties we face,” Marmor said.
Many people blame the lobbying power of the health insurers, hospitals and pharmaceutical companies for the inability of the Affordable Care Act to ignore costs, but Marmor begs to differ. It wasn’t the lobbying pressure that held back politicians from tackling these larger issues, but the false presumption that the Republican Party could topple this provocative legislation.
“There’s no question lobbying took place,” he said. “But the claim that Obama needed Republican votes turned out to be false.” In the end, the ACA passed both houses of Congress without any Republican support.
President Obama, for his part didn’t know anything about medical care history, Marmor said, calling him a policy generalist who lacked an independent source of understanding. Instead Obama relied on Tom Daschle, the former U.S. Senator from South Dakota and former U.S. Senate Majority Leader.
Daschle was infected by regrets over the intransigence of the Clinton reforms in 1993-1994 and wanted to avoid the huge disappointment that took place then. “But,” Marmor said, “politics was different then, and the Democrats didn’t have in 1994 anything like the control of Congress they had in 2008-09.”
The ACA, he said, was based on delivery system reforms – pay for performance, electronic medical records, primary care medical homes – which he called well and good, but they do nothing to hold down costs.
Furthermore, the politicians totally ignored the international experience of Canada, Great Britain and Germany, which rely on global budgets, system wide fee schedules and an all-payer or single payer health system to limited spending.
“The Obama administration had trouble responding to partisan attacks because the Democrat plan – built on the complicated status quo – offered no clear conception of how Americans would benefit from reform,” Marmor told The Lund Report, “And, the institutional constraints of American politics had enormous influence on the health reform debate and the legislative outcome – which explains why the reformers relied on a patchwork plan even though Democrats had sizeable congressional majorities.”
Built into this odd process, he said, was the bizarre way people refer to health insurance, referring to valuable jewels – platinum, gold and silver -- almost as if they’re shopping for a wedding ring, he added.
Marmor’s in Portland to compete in the Wrightson Cup, US Squash Foundation championships at the Multnomah Athletic Club. .
His talk on Thursday night is also co-sponsored by the Division of Management, School of Medicine, Oregon Health & Science University, OHSU-PSU MBA in Healthcare Management; Oregon Physicians for a National Health Program; We Can Do Better, the Institute for Healthcare Improvement, PSU & OHSU Open School Chapter and the Mark O. Hatfield School of Government, Portland State University, PhD in Health Systems and Policy.
For the past three decades, Marmor has taught at Yale and is the author (or co-author) of 13 books, as published over 200 articles in a wide range of scholarly journals, and his opinion essays have appeared in major US newspapers—including the Wall Street Journal, New York Times, Washington Post, Los Angeles Times, Philadelphia Inquirer and Boston Globe. He was also an advisor to President Jimmy Carter and Walter Mondale in his race for the presidency in 1984. Diane can be reached at [email protected].
