President Obama has identified yet another sector of the economy in dire need of government help: higher education. And it seems he wants to use ObamaCare as the model for improving education quality and lowering cost. The one teensy-weensy problem is that ObamaCare will do neither.
The president wants bureaucrats at the Department of Education to set up a college ranking system and peg federal financial aid to those that follow government guidelines. Those colleges that adhere to the bureaucrats’ vision of a good education will get more money, those that don’t will get less—or none at all.
Handing out money to those who agree with him is the president’s way of ensuring that social institutions embrace his liberal vision.
Given that Obama infuses his social agenda into everything, you can bet that colleges that offer a major in, say, transsexual social affirmation, will be smiled on more than conservative Christian colleges that don’t. You might also expect that colleges that make pregnancy services (read: abortion) available on demand will be considered a better value than those that shun such practices.
That happens to be the same approach he’s taking in health care. Maybe we should dub his education initiative “ObamaScore.”
The president has several possible quality-and-cost-related options to draw from in ObamaCare; two of them are the Independent Payment Advisory Board (IPAB) and Accountable Care Organizations (ACOs).
The IPAB is supposed to be a panel of 15 independent experts, appointed by the president and confirmed by the Senate, who will recommend cuts to Medicare if the program exceeds designated spending levels.
Critics of IPAB dubbed it a “death panel” because cutting reimbursements to doctors and drug companies (and hospitals and nursing homes in the future) could effectively ration care.
Defenders sniff that the IPAB is prohibited from rationing care. Would that be like IRS employees being prohibited from targeting conservative groups or releasing donor and other sensitive information? Just wondering.
But that defense is disingenuous. If seniors can’t find a doctor to treat them because Medicare doesn’t pay enough—a problem that already exists but could get much worse under IPAB—or if they cannot get a needed prescription drug because the panel thinks it’s too expensive, that is a back-handed way of rationing care.
Another ObamaCare cost control mechanism is the ACO. These are essentially the old health maintenance organizations (HMOs) on steroids. The public largely rejected HMOs in the 1990s, believing they had become a tool for rationing health care. And a number of state legislatures passed laws, known as patients’ bill of rights, limiting HMO practices. Well, they’re back.
According to the Washington Post, there are currently more than 400 ACOs in operation. But they didn’t emerge because of consumer demand; the federal government is funneling billions of taxpayer dollars to them. So it is unsurprising that most ACOs claim to be making great progress toward the goals of improving quality and lowering costs—as they wait for that next check. The data, however, are less optimistic.
The government recently released a report claiming that 32 early health-system adopters dubbed the Pioneer ACOs have demonstrated improved quality of care but more than half did not lower costs. So a partial success, right? Probably not. Only 13 of the Pioneers earned bonuses and nine dropped out of the program.
Part of the problem is that no one really knows how to measure quality in health care, which allows just about any group to claim it is improving quality. There were initially supposed to be 70 quality measures, but providers balked at that number so it was reduced to 33. And last March several hospitals implementing the ACO vision asked for a one-year delay in the requirement to report quality metrics.
And in the midst of the debate over IPAB and ACOs’ ability to improve quality and lower costs, we are seeing countless stories about how health insurance premiums will be rising significantly under ObamaCare.
Now Obama wants to bring this same questionable record to higher education by setting up the equivalent of an IPAB or ACO for colleges.
To be sure, the U.S. higher education system is in dire need of reform. As Professor Richard Vedder (along with many others) has recently argued, college is very expensive and the value proposition (i.e., the prospect of higher earnings compared to the money spent) is increasingly questionable.
But as Vedder points out the high cost and diminishing returns of college are largely a result of federal government involvement, not the lack of it. And now the president wants to double-down on the government’s role. To paraphrase humorist P.J. O’Rourke, you think college is expensive now, wait until Obama tries to make it affordable.