Wednesday, July 18, 2012

Tim Pawlenty's Courage to Stand 10: GAMC

I finished Tim Pawlenty's Courage to Stand.

There were a variety of interesting items in my latest reading of this book.  First, I appreciated Pawlenty's distinction between radical Muslims and other Muslims, in light of the tendency of a large portion of the right-wing to lump all Muslims together as evil.  Second, Pawlenty criticizes President Barack Obama for alienating the United States' allies----Poland, the Czech Republic, and Israel----and for supporting an arms treaty with Russia "that favors Russia and all but affirms Russia's decision to help Iran fire up a nuclear energy reactor" (page 292).  I don't know a whole lot about this issue, so I really can't critique Pawlenty on this right now, but I've decided to make a note of it.  Third, Pawlenty asks why we need NPR and PBS when there are already so many radio and cable TV programs.  I have an answer to that: because NPR and PBS actually offer quality programming.

I'd like to turn my focus to health care, since that is an issue that is of interest to me.  On pages 283-285, Pawlenty talks about General Assistance Medical Care (GAMC) in Minnesota, a government program.  According to Pawlenty, "GAMC provided unlimited health care for low-income single adults without kids."  But its costs were rising because (according to Pawlenty) "It was an old-style 'fee for service' setup that paid providers for how many procedures they performed without much accountability for cost control or quality outcomes."

Pawlenty narrates that he was emotionally impacted by a man in a wheelchair in Mankato (which I know from Little House on the Prairie), who plead with Pawlenty not to cut his health care.  But Pawlenty says that his goal as Governor was to move the beneficiaries of GAMC to MinnesotaCare, another health care program for disadvantaged people.  Pawlenty states that MinnesotaCare "had benefits that were more limited than GAMC, and the switch would be more affordable to the state."  Pawlenty reached a compromise with the state legislature: Instead of giving GAMC a "blank check", the government would give hospitals a lump sum to treat "a fixed number of GAMC patients."  Pawlenty states that, under this policy, "Providers now had incentive to focus on the wellness of GAMC patients and health-care outcomes rather than how many procedures they performed."

This sounds a lot like rationing, which many on the right love to condemn when it comes to government health insurance.  But there is a degree of wisdom in Pawlenty's policy, in my opinion: Rather than giving providers an incentive to order more and more tests for patients in order to get more money for themselves, why not give the providers a lump sum, and that could encourage them to try to get healthy results for their patients for a low cost, with the lump sum that the government gives them?  I hope, however, that this would not lead to the providers denying patients the care that they need.  I fear that it might.

UPDATE: I talk here about Ezra Klein's contention that moving Medicare away from a fee-for-service model was one of the conservative ideas that Obamacare adopted.

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