The New Health Dialogue

Fixing our broken health care system is a complex task. With this complexity comes both healthy debate and damaging misrepresentations. Few misconceptions are more seriously wrong than the judgment that current health reform legislation does not do nearly enough to control health care costs. Despite what opponents say, the health care reform legislation before Congress succeeds in two important tasks:

1) It makes clear that the U.S. government will not perpetuate our current payment system that rewards volume over value. Specifically, fee-for-service payment -- where doctors and hospitals are paid more, the more care they deliver, regardless of quality -- in the Medicare program will no longer be profitable.

2) It changes incentives in public programs to promote coordinated, patient-centered care, thereby inspiring private payers to do the same. The Senate bill goes further and includes both an Advisory Board designed to guarantee that reform slows the rate of cost growth in public programs and an excise tax on insurers who offer high cost policies that will encourage more value-based insurance products that deliver more efficient care. A complete list of valuable reforms is included in a more comprehensive memo, available here. But the legislation includes the vast majority of the ideas put forth by a broad coalition of health care leaders who make up Health CEOs for Health Reform , as well as leading academic researchers at the Brookings Institute, lead by former CMS chief under President George W. Bush, Mark McClellan.

This is not to say that reform legislation cannot be strengthened. It can and should be strengthened. For example, Health CEOs for Health Reform propose examining and reforming the legal and regulatory barriers -- like anti-trust, self-referral, and medical malpractice laws -- to high-quality, coordinated care. Analysts and many stakeholders would prefer that the legislation -- specifically the Advisory Board -- focus on the health system as a whole, not just Medicare and Medicaid, and not just specific providers. I remain optimistic that both of these improvements could make their way into the final package. In fact, the freshman Senate class just proposed a package of cost-bending and quality-boosting amendments that would go a long way to accomplishing these goals.

Meanwhile, critics claim these bills are not serious enough about slowing the rate of health care cost growth. But how do critics propose to control the growth in health care costs? What specifically is missing from the bills that they believe will make health care more affordable? As Bob Dylan would say, “the answer, my friend, is blowin’ in the wind.”

Most critics do not have any specific recommendations. Many people opposed to reform point to malpractice reform as a lost cost-saving opportunity. But the reality is twofold: 1) there’s a dispute about whether the authority to reform malpractice resides with the federal government -- it’s traditionally been a state matter, 2) even states with aggressive malpractice reforms including caps on damages have not slowed the underlying rate of health care cost growth and credible analysts, including the CBO, predict that even significant malpractice reforms will not reduce costs substantially. Testing new approaches to medical malpractice is certainly important for clinician peace of mind as we bring about other changes in our health care delivery system, but it will never achieve the scale of savings we need.

What is most frustrating is that the very people screaming about “rationed care” are some of the self-same budget hawks who know that getting Medicare spending under control is the key to long-term fiscal stability. Bending the cost curve to bring health care cost growth more in line with growth in the economy does not necessitate drastic cuts or rationed care, nor does it weaken the Medicare program. Just ask the AARP. Further, there is no denying CBO’s prediction: health care reform legislation before Congress will reduce the budget deficit. Indeed, they predict the Senate bill will reduce Medicare cost growth by two percentage points per year for the next two decades! Since when is that a bad thing?

Opponents of reform would like Americans to think the current bills fail to bend the curve. Maybe because political foes want to deprive President Obama of a victory that has eluded presidents since Teddy Roosevelt. Maybe because they cannot accept that the role of government must change somewhat for our health system to become accessible, affordable, and efficient for all Americans. But facts are facts. We should not allow opponents to obscure the reality and potential for the bills before Congress to make health care more affordable for all Americans within a decade. And we certainly cannot take seriously opponents who fail to back up their critiques with credible alternatives.

Next week we'll be back with more. We'll try to shed some more light on some of the misunderstood, or unfairly maligned, sections of the bill that will lower costs and help us create a more sustainable, high quality health care system for all.