What Are the Odds for Health Reform?

Betting against the house: the medical industrial complex and its political allies

Warning flags are up again! Despite all the well-documented problems people have in getting insurance, staying insured, getting care that doesn’t kill them, and paying for it; despite all the momentum and grassroots interest the primaries have generated, the signals keep coming that the promise of substantive health reform may be nothing more than a political illusion.

In May, Campaign Desk noticed how some influential senators were peddling an ominous narrative: The country is not ready for major reform—which would cost too much anyway, by God! We need time to do it right, and heaven forbid we should rush into anything! Now comes a blast from the past from ex-senator Dr. Bill Frist, the former Republican majority leader of the U.S. Senate and candidate-in-waiting for the Tennessee governorship. While addressing a conference in Nashville, Frist told a group of some 3000 hospital officials and suppliers that systematic health reform is not likely to happen under the next president:

Ultimately, what will happen, probably, is that we won’t have major health care reform over the next four years. We will continue to have incremental reform that moves towards the marketplace in the sense of having more competition, slight expansion of benefits, covering more of the uninsured, but doing it in a way that is responsible from a cost standpoint. On the Republican side, manifested by John McCain, is the view that we have to get the cost of health care under control, before we make promises for unlimited health care for everybody in the country.

This spring, Frist (who has been on something of a speaking tour lately) told members of the Chattanooga Rotary Club that health reform should begin with a more efficient and market-driven system, rather than broad expansion of insurance coverage. Apparently, Frist believes that relief for forty-seven million uninsured Americans (or some portion thereof) must wait until the U.S. figures out how to stop the out-of-control price of medical care, which clearly increases insurance premiums while contributing handsomely to many health care sellers’ bottom lines.

The ex-senator chatted with a Nashville City Paper reporter after his talk. But if he told her how the country should get health care costs under control, the paper didn’t report it. Instead, the paper informed its readers that Frist said he would campaign for John McCain (as if they had to be told) and that he would decide early next year whether to run for governor (as if that’s big news).

Here’s a thought for the Nashville City Paper, the Nashville Tennessean, and other news outlets that might be inclined to cover Dr. Frist’s words in the coming months: Why not incorporate them into a comprehensive analysis of why health care costs so much? Such an assessment could begin with hospitals and, perhaps, even the Hospital Corporation of America (HCA)—the Frist family business, a chain of 169 for-profit hospitals and 109 freestanding surgical centers started by Frist’s father and brother. His brother still serves on the board. Frist himself has been a stockholder.

For journalists wanting to tackle the subject, here’s a good source to start with: Maggie Mahar’s Health Beat blog. Health Beat looked at health care spending and found that hospitals account for one-third of our $2 trillion health care tab. Since 2000, hospital spending has increased from 5 to 8 percent each year. Hospitals have embarked on a building boom, the biggest since the late 1960s. Both for-profit and non-profit hospitals are investing in new and expensive technology that demands new and expensive facilities. The costs get passed along to insurance companies that pay the hospitals, which, in turn, pass the increased costs on to employers and individuals who buy the actual policies, which are increasingly unaffordable.

Innovation, and not the need for more beds, is fueling the expansion fires, Mahar says. So the next time politicians say that something must be done about the high cost of medical care, journalists should ask them how they plan to say “no” to the local hospital. Or, in the case of Dr. Frist, how long the uninsured will have to wait before they get some insurance coverage. But maybe Frist will take more of a personal interest in the matter: HCA recently told investors that the number of uninsured seeking care at its facilities over the past year had gone up.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.