Curbing Healthcare Costs the German Way

Uwe Reinhardt makes a case for one part of the German healthcare model:

An outside body of health policy specialists and stakeholders would be able to inform America’s health policy. It could provide insights from detached research and a consensus among experts and stakeholders, in place of the campaign contributions of powerful interest groups that now drive policy.

The Medicare Payment Advisory Commission, for example, could serve as such a body.

... 

To understand how such a body might function, Americans could learn from Germany’s experience with precisely such a body — Der Gemeinsame Bundesausschuss or, in English, the Joint Federal Committee.

Germany’s joint committee was established in 2004 and authorized to make binding regulations growing out of health reform bills passed by lawmakers, along with routine coverage decisions. The ministry of health reserves the right to review the regulations for final approval or modification. The joint committee has a permanent staff and an independent chairman.

...Its main tasks include making evidence-based coverage decisions for ambulatory and inpatient services and medical products and furthering disease-management programs.

To arrive at its coverage decisions, the committee seeks scientific input from its nonprofit subsidiary, the Institute of Quality and Efficiency in Health Care. It conducts cost-effectiveness analyses for particular procedures or medical products, mainly on the basis of research done by academic or other outside research institutes.

There's little question that this sort of centralized effectiveness-based review would probably make the U.S. healthcare system more orderly and efficient. What else would you expect from a German idea?

What I think Reinhardt seriously underestimates, however, are the cultural obstacles such a plan would face. Americans trust experts less than Germans, for one thing. People who want treatments the commission doesn't approve will form pressure groups, go on television, and call their congressmen. Americans also have a more decentralized, federalist mindset. I can already see the campaign commercials and Republican speeches: "Obama put a group of unelected bureacrats (or 'so-called experts') in Washington, D.C. in charge of your healthcare." (cue ominous music).  The typical German reacts with a shrug to such assertions, but Joe Sixpack regards them as powerful arguments. 

There may be some way to package this idea more palatably, perhaps by hiding it behind a bunch of sleep-inducing bureaucratic jargon. Whoever heard of the Medicare Payment Advisory Commission, after all? For that matter, how many Germans are even aware of the Gemeinsamer Bundesausschuss, which -- nota bene -- does not even mention health care in its own name? I'm all for Reinhardt's idea, but it would be a mistake to trumpet it out-front as a cost-saving measure. Better to slip it quietly into some omnibus bill.

Comments

[Norbert]

Excuse me for bringing this old post up again, but I am wondering: doesn't the US Joint Commission fulfill the cited criteria as well:
- centralized healthcare evaluation entity
- a group of unelected bureaucrats
- does not even mention health care in its own name

[Sandy]

My son has been living in Germany for a number of years now. He has married a German girl and they have a beautiful family. He is reluctant to move them here to the United States because health care is sooooo much better in Germany.

[James]

I came back to the US in 2004 after 10 years in Germany. I had lost my job in a 1-2 punch of economic slowdown and re-organizing priorities. In Germany, I was better insured as an unemployed foreigner than I am now as a working American. Verstehe nicht, wie das sein kann...

[bschl]

"Americans trust experts less than Germans..."

*lol*

That reads:

"Germans are more trusted than experts."

8-)

I like that one!