Philip K. Howard

Containing health care costs seems to me to be a moral imperative. If the experts are right that the inefficiency exceeds $700 billion per year, that's $700 billion that could be used for many critical needs, including restoring fiscal stability to America. Containing costs, as I and others have written, requires realigning incentives for both patients and providers. One source of waste--important but not the largest--is the defensiveness that pervades the… More »

The Senate health care bill does nothing to address the unreliable malpractice system. Actually, it's designed to prevent fixing the malpractice system. How the bill does this is painfully apparent to me--because I put together the first draft of a malpractice amendment at the request of a Democratic policy expert who deals with members of Congress on these issues. Here's how the reform proposal got transformed into a bulwark for trial lawyers to bar possible… More »

The big story of the health reform debate is not what the bills provide, but what they don't provide--no liability overhaul and no serious effort at cost-containment. American healthcare may bankrupt the country unless the waste and inefficiency--an estimated 30% to 40% of total costs--is wrung out of the system. The waste is $700 billion to $1 trillion every year. There can be no greater domestic priority. Building a coherent new framework, however, is almost… More »

James Fallows has an insight on the Fort Hood shootings that I feel is wise: "The shootings never mean anything. Forty years later, what did the Charles Whitman massacre 'mean'? A decade later, do we 'know' anything about Columbine? There is chaos and evil in life. Some people go crazy." I would add that the felt need to learn a lesson from individual madness often leads to institutionalized madness--as with the "zero tolerance" rules that sprouted up in… More »

The President committed in his speech to Congress to promote pilot projects to solve the problem of defensive medicine. "I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs," he stated. "So I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine." Creating special health courts is the proposal advanced by most serious observers… More »

President Obama took an important step away from special interest politics when he committed to changing justice to solve the problem of defensive medicine in his address to Congress. "I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my… More »

It is incredible to me that, amid public concern over the leading healthcare proposals, congressional leadership continues to stonewall any discussion of legal overhaul. They have effectively left the field open to Republicans, who now have seized the center with proposals for special health courts and other ideas that enjoy broad support from almost all healthcare constituents, including consumer groups and patient safety advocates. See here, here and here. I know… More »

For the past few weeks, I've been talking with healthcare experts with a variety of perspectives, trying to discover coherent principles for overhauling American healthcare. This requires, in my view, testing every idea against its likely effect on the real people who provide healthcare services and on the real people who need those services. What's ultimately required is to change the culture of healthcare delivery. Congress doesn't seem to be tethered to the… More »

The goals of reform are clear: provide universal care that is affordable. So far, however, Congress has avoided any proposals that would require a major organizational shake-up--tabling Senators Wyden (D-OR) and Bennett's (R-UT) "Healthy Americans Act" ("Wyden-Bennett"), because it would eliminate employer-based healthcare as we now know it. (Senator Wyden/http://www.flickr.com/photos/pirateyjoe/3642123174)Conceptually, the most obvious way to achieve universal… More »

The debate gearing up around the nomination of Judge Sonia Sotomayor has little to do with her qualifications (undeniably impressive) and everything to do with a partisan referendum on the role of judges in a free society. You can practically already hear the senators' speeches, rewound from the last hearings. Conservatives will say she is "activist" and "result oriented," while liberals will praise her "empathy" and commitment to the "rights" of the downtrodden.… More »

The Supreme Court's Ricci decision --the decision deferred to the choices of officials who are accountable politically. She and her fellow judges can be criticized, I suppose, for not writing an opinion explaining their decision to affirm the trial court. But what were they supposed to say? The Supreme Court has now given legal priority to the need to avoid "reverse discrimination," but that conclusion was hardly compelled by prior jurisprudence. There's a… More »

Just a few months ago, members of Congress took turns wagging their fingers at CEOs of the automakers for not making tough choices--not shedding "legacy costs," not making products consumers wanted, not cutting bloated bureaucracies. Detroit had become self-referential, unable to compete because it was unwilling to deal with its internal constituents.Now Washington faces a series of domestic crises that will shape the health of our society for… More »

This was the week to state the problem. Obama told the AMA that healthcare costs are "unsustainable" and "a ticking time bomb"--on a trend to consume one in three dollars of GDP in three decades (see here). The CBO released a report saying that reforms currently on the table might raise costs, not lower them (see here). Three former majority leaders issued their own plan to pay for healthcare--higher taxes and lower reimbursements (see here). Then The New York… More »