The RAND Corporation’s Dash for Health Care Reform

Giving more ammunition to the argument that getting a handle on costs before the sweeping cart-before-the-horse approach favored by RANDCOMPARE’S policy changes, Winifred Hayes, MS, PhD, RN, and CEO of Hayes, Inc., a health technology assessment and consulting firm, uses evidence-based assessments of health technologies to help providers and payers calculate costs and benefits. There is ongoing debate about the value of many technologies. Having a DaVinci robot, for example, may give a hospital a marketing edge and impress physicians and consumers, but the technology is very expensive, and there’s no solid evidence of better outcomes, she said.

Similarly, while Loma Linda University Medical Center and others have invested in proton radiation therapy in addition to having a gamma knife, putting a price tag on proton technology’s higher accuracy and fewer side effects is a major decision. Dr. Hayes also pointed out that an unintended consequence of government-sponsored or mandated coverage is that it will undermine employer-sponsored coverage, which currently provides 61% of all health insurance.

Objectivity Questioned

Before the legislative gofers and the media who are actively exploring health care policy navigate heavily with RANDCOMPARE, they should carefully scrutinize the dashboard (see A Close Look at One Policy Option). Dr. McGlynn’s explanation that important policy options weren’t included in COMPARE’s launch but will be included later indicates a certain haste in pushing the product out the door. She also mentioned that a National Health Exchange similar to Massachusetts’ Connector would be a national rather than a state plan. Similarly, whereas RAND’s dashboard claims there is no evidence on the impact of purchasing pools on spending, the National Association of State Comprehensive Health Insurance Plans (NASCHIP) provides a plethora of data on purchasing pools, different state models, and what ideal plans cost and look like.

What’s missing in mandates is that someone has to pay for them, and our data aren’t sophisticated enough to put accurate price tags on medical services.

-Sreedhar Potarazu, MD, MBA

While RANDCOMPARE deals with health care’s growth in spending that annually outpaces inflation consistently, it identifies widespread systemic waste in administrative, operational, and clinical areas. It hints that switching to a Canadian-style system might cut waste substantially. However, it never addresses the systemic waste caused by state mandates that cover chiropractic, acupuncture, massage therapy, wigs, mental health parity, drug and alcohol rehabilitation, in vitro fertilization, and other services that politicians find difficult to oppose for fear of alienating motivated voters.