Parsing Health Policy Instead of Politics

So spoke President Barack Obama during his visit to St. Charles, Mo., on Wednesday. The president's appearance, and the protests it inspired, made for compelling television. There was no shortage of political analysis, before or after.

But the policy proposals the president outlined did not get the same attention. They're wonkish and far more difficult to understand than protest placards and sound bites.

That has been the fundamental problem with Mr. Obama's campaign to reform health care. He's talking to Americans as if they were adults. And too many of them are responding like spoiled children.

In St. Charles, Mr. Obama announced an expansion of a program that uses outside auditors to review Medicare and Medicaid billing records to root out overpayments and mistakes. Auditors would be paid based on how many errors they uncover.

Hospitals and doctors hate these audits because Medicare and Medicaid billing rules, like those for private insurance, are complex. Doctors and hospitals can make mistakes even if they are being honest.

Meanwhile, auditors have the incentive to question everything, even innocent or relatively minor mistakes. Responding to them is time-consuming and expensive for doctors and hospitals.

But that does not mean audits should not be done. As Mr. Obama noted, some estimates put the amount of "improper payments" — fees paid to the wrong person, in the wrong amount or for services that never were provided — at $100 billion a year.

That is a lot, but it pales in comparison to the legitimate payments made to doctors, hospitals and suppliers for care that does not benefit patients or that is not needed.

Mr.

Obama didn't talk much about reducing those expenses, which some experts say are as much as eight times greater than the amount of improper payments. To his credit, though, his reform plan would lay the groundwork for doing so.

Many experts believe the reform plan has the potential to generate hundreds of billions of dollars a year in savings. But such complexities make lousy television.

Mr. Obama's reforms limit the ability of insurance companies to deny care for pre-existing conditions or to cancel policies after a patient gets sick.

His reforms would establish a national marketplace in which small businesses and individuals could buy insurance with standard benefits from private companies. That would encourage competition and comparison shopping.

And they would change the way the government — and, eventually, everyone — pays for health care by rewarding quality instead of quantity.

Those are moderate ideas. But extremists have portrayed them as radical. They complain that government should have no role in providing health care.

That criticism has stuck, as Mr. Obama noted. "One of the things I've heard from a lot of seniors was 'Keep your government hands out of my Medicare.'"

Medicare, for those who haven't heard, is a government program. Now, 45 years after Medicare was created, middle-class families are the ones who can't find insurance, not older retirees. Reform would give the rest of us the security that older adults now enjoy.

There's no doubt it can be done. The only question is when. That's a matter of politics, not policy.

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