Ah, Capitol Hill. Just when you start to have high hopes that our elected representatives are taking on the important issues--in this case, a hearing about consolidation in the healthcare industry--you get a reminder of why Congress' approval rating is abysmally low.
"I've got a parliamentary inquiry, Mr. Chairman: Who controls the time during my questioning of my witnesses?
"You didn't give him the opportunity to answer the question–you kept cutting him off."
"My time is running because of your interruption of my questions."
That was a brief, but uncomfortable display of quarreling between Regulatory Reform, Commercial and Antitrust Law Subcommittee Chairman Tom Marino (R-Pa.) and ranking subcommittee member Henry Johnson (D-Ga.). In short, Johnson was upset that Marino cut short his attempt to get witness Scott Gottlieb, M.D., to answer his question, and Marino took issue with Johnson's protestations.
Eventually, Marino relented and let Johnson continue his questioning, but not before the message had been heard loud and clear--this was not going to be a hearing free of partisan politics. After all, any discussion of healthcare policy inevitably turns to the elephant in the room: The much-exalted and yet much-demonized Affordable Care Act.
Speaking of demonization, some lawmakers at the hearing characterized the healthcare reform law as "perversely named," "gruesome," "a terrible law" and "an experiment that has gone horribly wrong."
Whatever you think of the ACA--and it's far from perfect--can we all agree that excessive hyperbole does little to advance productive discourse? I can assure you there is plenty more "gruesome" stuff going on at hospitals than healthcare reform.
Then again, in spite of two Supreme Court decisions in the law's favor, it's not as though the fight over the ACA is over. Just this week a judge ruled that House Republicans have the legal standing to sue the Obama administration over its spending on ACA subsidies.
Meanwhile, law professor and healthcare antitrust expert Thomas Greaney told the committee members point-blank that it's "entirely erroneous" to argue the ACA itself drove healthcare consolidation. Before healthcare reform, he reminded the committee and a packed house of spectators, healthcare was a "dysfunctional market" with entities operating in silos and a payment system that rewarded volume rather than outcomes.
And the "doomsday predictions" about the ACA, including projections that risk selection would destroy the exchanges, policies would be unaffordable and employer-sponsored markets would crumble, "have proved to be wrong, wrong and wrong," he said.
The ACA also forbade insurers from engaging in medical underwriting, essentially telling them to "do your job" by developing health plans that control costs and improve quality rather than chase risk. And most importantly, Greaney added, the law created efficient ways of shopping and bargaining in the individual and small-group market--which he says actually serves to increase competition.
But like nearly every other expert at the hearing, as well as many of the members of Congress, Greaney was skeptical of the major proposed health insurance mergers. Even if the mergers create cost-saving efficiencies--the crux of the America's Health Insurance Plans (AHIP) representative's argument for consolidation--there's no evidence these savings will be passed onto consumers, Greaney noted.
It was very clear, however, that this hearing was simply the warm-up round for the real fight over the insurer mergers. While American Hospital Association President Rick Pollack repeated his organization's argument against insurer consolidation, he spent even more time explaining why provider consolidation is a natural and necessary side effect of health reform. He also took a shot at AHIP's testimony that provider consolidation has increased healthcare costs, arguing that the claim is based on old data.
As mentioned during Thursday's hearing, future hearings will focus specifically on the insurer deals, all while the Department of Justice conducts a rigorous review of their antitrust effects. If the most recent hearing is any indication, they're bound to feature plenty of lively back-and-forth between payers, providers and other experts as they debate the merits of the mergers.
What would be nice is if our elected representatives could stop bickering about the ACA--and whose turn it is to ask questions--long enough to listen. - Leslie @HealthPayer