Health_NN1 'Reform'_NN1 Gets_VVZ a_AT1 Failing_JJ Grade_NN1 As_II the_AT dean_NN1 of_IO Harvard_NP1 Medical_JJ School_NN1 I_PPIS1 am_VBM frequently_RR asked_VVN to_TO comment_VVI on_II the_AT health-reform_JJ debate_NN1 ._. 
I_PPIS1 'd_VM give_VVI it_PPH1 a_AT1 failing_JJ grade_NN1 ._. 
Instead_CS21 of_CS22 forthrightly_RR dealing_VVG with_IW the_AT fundamental_JJ problems_NN2 ,_, discussion_NN1 is_VBZ dominated_VVN by_II rival_JJ factions_NN2 struggling_VVG to_TO enact_VVI or_CC defeat_VVI President_NNB Barack_NP1 Obama_NP1 's_GE agenda_NN1 ._. 
The_AT rhetoric_NN1 on_II both_DB2 sides_NN2 is_VBZ exaggerated_VVN and_CC often_RR deceptive_JJ ._. 
Those_DD2 of_IO us_PPIO2 for_IF whom_PNQO the_AT central_JJ issue_NN1 is_VBZ health_NN1 --_NN1 not_XX politics_NN1 --_NN1 have_VH0 been_VBN left_VVN in_II the_AT lurch_NN1 ._. 
And_CC as_CSA controversy_NN1 heads_NN2 toward_II a_AT1 conclusion_NN1 in_II Washington_NP1 ,_, it_PPH1 appears_VVZ that_CST the_AT people_NN who_PNQS favor_VV0 the_AT legislation_NN1 are_VBR engaged_VVN in_II collective_JJ denial_NN1 ._. 
Our_APPGE health-care_NN1 system_NN1 suffers_VVZ from_II problems_NN2 of_IO cost_NN1 ,_, access_NN1 and_CC quality_NN1 ,_, and_CC needs_VVZ major_JJ reform_NN1 ._. 
Tax_NN1 policy_NN1 drives_VVZ employment-based_JJ insurance_NN1 ;_; this_DD1 begets_VVZ over_II insurance_NN1 and_CC drives_NN2 costs_VVZ upward_RL while_CS creating_VVG inequities_NN2 for_IF the_AT unemployed_JJ and_CC self-employed_JJ ._. 
A_AT1 regulatory_JJ morass_NN1 limits_VVZ innovation_NN1 ._. 
And_CC deep_JJ flaws_NN2 in_II Medicare_NP1 and_CC Medicaid_NP1 drive_NN1 spending_VVG without_IW optimizing_VVG care_NN1 ._. 
Speeches_NN2 and_CC news_NN1 reports_NN2 can_VM lead_VVI you_PPY to_TO believe_VVI that_DD1 proposed_JJ congressional_JJ legislation_NN1 would_VM tackle_VVI the_AT problems_NN2 of_IO cost_NN1 ,_, access_NN1 and_CC quality_NN1 ._. 
But_CCB that_DD1 's_VBZ not_XX true_JJ ._. 
The_AT various_JJ bills_NN2 do_VD0 deal_VVI with_IW access_NN1 by_II expanding_VVG Medicaid_NP1 and_CC mandating_VVG subsidized_JJ insurance_NN1 at_II substantial_JJ cost_NN1 --_NN1 and_CC thus_RR addresses_VVZ an_AT1 important_JJ social_JJ goal_NN1 ._. 
However_RR ,_, there_EX are_VBR no_AT provisions_NN2 to_TO substantively_RR control_VVI the_AT growth_NN1 of_IO costs_NN2 or_CC raise_VV0 the_AT quality_NN1 of_IO care_NN1 ._. 
So_RR the_AT overall_JJ effort_NN1 will_VM fail_VVI to_TO qualify_VVI as_II reform_NN1 ._. 
In_II discussions_NN2 with_IW dozens_NNO2 of_IO health-care_NN1 leaders_NN2 and_CC economists_NN2 ,_, I_PPIS1 find_VV0 near_II unanimity_NN1 of_IO opinion_NN1 that_CST ,_, whatever_DDQV its_APPGE shape_NN1 ,_, the_AT final_JJ legislation_NN1 that_CST will_VM emerge_VVI from_II Congress_NN1 will_VM markedly_RR accelerate_VVI national_JJ health-care_NN1 spending_NN1 rather_CS21 than_CS22 restrain_VVI it_PPH1 ._. 
Likewise_RR ,_, nearly_RR all_DB agree_VV0 that_CST the_AT legislation_NN1 would_VM do_VDI little_DA1 or_CC nothing_PN1 to_TO improve_VVI quality_NN1 or_CC change_VV0 health-care_NN1 's_GE dysfunctional_JJ delivery_NN1 system_NN1 ._. 
The_AT system_NN1 we_PPIS2 have_VH0 now_RT promotes_VVZ fragmented_JJ care_NN1 and_CC makes_VVZ it_PPH1 more_RGR difficult_JJ than_CSN it_PPH1 should_VM be_VBI to_TO assess_VVI outcomes_NN2 and_CC patient_JJ satisfaction_NN1 ._. 
The_AT true_JJ costs_NN2 of_IO health_NN1 care_NN1 are_VBR disguised_VVN ,_, competition_NN1 based_VVN on_II price_NN1 and_CC quality_NN1 are_VBR almost_RR impossible_JJ ,_, and_CC patients_NN2 lose_VV0 their_APPGE ability_NN1 to_TO be_VBI the_AT ultimate_JJ judges_NN2 of_IO value_NN1 ._. 
Worse_JJR ,_, currently_RR proposed_JJ federal_JJ legislation_NN1 would_VM undermine_VVI any_DD potential_NN1 for_IF real_JJ innovation_NN1 in_II insurance_NN1 and_CC the_AT provision_NN1 of_IO care_NN1 ._. 
It_PPH1 would_VM do_VDI so_RR by_II over_II regulating_VVG the_AT health-care_NN1 system_NN1 in_II the_AT service_NN1 of_IO special_JJ interests_NN2 such_II21 as_II22 insurance_NN1 companies_NN2 ,_, hospitals_NN2 ,_, professional_JJ organizations_NN2 and_CC pharmaceutical_JJ companies_NN2 ,_, rather_II21 than_II22 the_AT patients_NN2 who_PNQS should_VM be_VBI our_APPGE primary_JJ concern_NN1 ._. 
In_II effect_NN1 ,_, while_CS the_AT legislation_NN1 would_VM enhance_VVI access_NN1 to_II insurance_NN1 ,_, the_AT trade-off_NN1 would_VM be_VBI an_AT1 accelerated_JJ crisis_NN1 of_IO health-care_NN1 costs_NN2 and_CC perpetuation_NN1 of_IO the_AT current_JJ dysfunctional_JJ system_NN1 --_NN1 now_RT with_IW many_DA2 more_DAR participants_NN2 ._. 
This_DD1 will_VM make_VVI an_AT1 eventual_JJ solution_NN1 even_RR more_RGR difficult_JJ ._. 
Ultimately_RR ,_, our_APPGE capacity_NN1 to_TO innovate_VVI and_CC develop_VVI new_JJ therapies_NN2 would_VM suffer_VVI most_DAT of_IO all_DB ._. 
There_EX are_VBR important_JJ lessons_NN2 to_TO be_VBI learned_VVN from_II recent_JJ experience_NN1 with_IW reform_NN1 in_II Massachusetts_NP1 ._. 
Here_RL ,_, insurance_NN1 mandates_NN2 similar_JJ to_II those_DD2 proposed_VVN in_II the_AT federal_JJ legislation_NN1 succeeded_VVN in_II expanding_JJ coverage_NN1 but_CCB --_JJ despite_II initial_JJ predictions_NN2 --_JJ increased_JJ total_JJ spending_NN1 ._. 
A_AT1 "_" Special_JJ Commission_NN1 on_II the_AT Health_NN1 Care_NN1 Payment_NN1 System_NN1 "_" recently_RR declared_VVN that_CST the_AT Massachusetts_NP1 health-care_NN1 payment_NN1 system_NN1 must_VM be_VBI changed_VVN over_II the_AT next_MD five_MC years_NNT2 ,_, most_RGT likely_JJ to_II one_PN1 involving_VVG "_" capitated_JJ "_" payments_NN2 instead_II21 of_II22 the_AT traditional_JJ fee-for-service_JJ system_NN1 ._. 
Capitation_NN1 means_VVZ that_CST newly_RR created_VVN organizations_NN2 of_IO physicians_NN2 and_CC other_JJ health-care_NN1 providers_NN2 will_VM be_VBI given_VVN limited_JJ dollars_NNU2 per_II patient_NN1 for_IF all_DB of_IO their_APPGE care_NN1 ,_, allowing_VVG for_IF shared_JJ savings_NN2 if_CS spending_NN1 is_VBZ below_II the_AT targets_NN2 ._. 
Unfortunately_RR ,_, the_AT details_NN2 of_IO this_DD1 massive_JJ change_NN1 --_NN1 necessitated_VVN by_II skyrocketing_VVG costs_NN2 and_CC a_AT1 desire_NN1 to_TO improve_VVI quality_NN1 --_NN1 are_VBR completely_RR unspecified_JJ by_II the_AT commission_NN1 ,_, although_CS a_AT1 new_JJ Massachusetts_NP1 state_NN1 bureaucracy_NN1 clearly_RR will_VM be_VBI required_VVN ._. 
Yet_RR it_PPH1 's_VBZ entirely_RR unclear_JJ how_RRQ such_DA unspecified_JJ changes_NN2 would_VM impact_NN1 physician_NN1 practices_NN2 and_CC compensation_NN1 ,_, hospital_NN1 organizations_NN2 and_CC their_APPGE capacity_NN1 to_TO invest_VVI ,_, and_CC the_AT ability_NN1 of_IO patients_NN2 to_TO receive_VVI the_AT kind_NN1 and_CC quality_NN1 of_IO care_NN1 they_PPHS2 desire_VV0 ._. 
Similar_JJ challenges_NN2 would_VM eventually_RR confront_VVI the_AT entire_JJ country_NN1 on_II a_AT1 more_RGR explosive_JJ scale_NN1 if_CS the_AT current_JJ legislation_NN1 becomes_VVZ law_NN1 ._. 
