Economist Lawrence Summers
He began with a great disclaimer, avowing that he had no special expertise on health care. Then he proceeded to sum up the country’s whole health care mess with such perfect pithiness that it made my toes curl.
Uber-economist Lawrence Summers, former secretary of the U.S. Treasury and former controversial president of Harvard, spoke yesterday at the inaugural Health Policy Symposium at Beth Israel Deaconess Medical Center. He’s back at Harvard now as a professor, and mostly speaks at note-taking speed, but I’ve had to paraphrase here and there. I’ll begin with the ending, which felt a bit like the kind of “Go forth and do good work” benediction he might have offered graduating Harvard seniors:
“This is all very, very difficult. And I guess the thought that I would want to leave you with, assessing this debate from the outside, is that if there is a happy end to this tale — if, looking back from 2030, we’re seeing that not just was the arc of justice bent towards liberty but the arc of health care costs was bent toward flatness — if that is what we look forward to, I think it is less likely that it came from a sweeping act of Congress and it is more likely that it came from widely emulated innovation in individual settings.
That it came from hospitals that found creative and inventive way to improve the quality of care and cut costs, and then whose procedure was so compelling that it had to be emulated elsewhere.
We are much more likely to succeed…from the bottom up than we are from the top down.
That it came from cities where coalitions of hospital providers and major employers worked out improved reimbursement understandings, found ways of fine-tuning reimbursements so that costs grew less rapidly.
We are much more likely to succeed, both with respect to the cost-containment challenge and with respect to the closely related quality challenge, from the bottom up than we are from the top down.
So my hope…would be that just as we live in a remarkable period of scientific innovation, we can live in a remarkable period of institutional innovation — and, if you like, social scientific innovation that points toward emulatable solutions to these problems.
President Clinton used to say that there was no problem in American education that had not been solved somewhere in America, and I suspect that most of the problems in health care have been solved somewhere in America. And our challenge is to match scientific innovation with innovation in patterns of practice, in provision of incentives, in monitoring and rewarding of outcomes.
It’s a feature of exponential growth that the stakes get larger every year. I think we are going to succeed with respect to broadening the availability of coverage very substantially, but I cannot claim that we’re securely on a path toward better cost-containment or improvement of quality. I think that’s the task for all of you.”
Now back to the beginning: Continue reading