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Delivery System Day: Len Nichols

len_nichols280x350.jpgLen Nichols directs the health-care policy program at the New America Foundation, and is usually my first call when I don't understand something.

The Chairman’s mark would create two new entities that could accelerate the delivery system reforms we need. One, a Center for Payment Innovation within the Department of Health and Human Services, is charged with testing, evaluating and expanding new payment models that could align incentives to delivery higher quality and more patient-centered care at lower cost.

The other, an Independent Medicare Commission with high profile members appointed by the president and confirmed by the Senate, would be charged with making recommendations to ensure that we accomplish cost growth reduction in ways that are consistent with high-quality patient care over time. Those recommendations would not be implemented automatically, but they would take effect fairly quickly after recommendation if Congress did not promulgate equally effective proposals on its own.

The creation of these new health policy players signals a seriousness of purpose about cost growth and quality enhancement that is impressive, especially after all the “rationing” rhetoric and lies were thrown around in town halls by some Republican leaders, and on Fox News and its echo chambers during recess.

One of the themes we're seeing here is that the bill contains a lot of funding provisions to help us innovate and experiment our way out of this mess. That's not a sure bet by any means, but it's worth trying. Hope, as they say, is not a plan. But if you pump it up with enough funding, maybe you can get a plan out of it. And in the meantime, you'll have the excise tax slowly bearing down on the system and making generous plans more expensive, and you'll have the insurance exchanges creating national competition on the coverage side. It's not so much a plan as a lot of plans.

Photo credit: New America Foundation

By Ezra Klein  |  September 22, 2009; 1:49 PM ET
Categories:  Health Reform  
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Next: What Washington Is Really Like


More accurately its not so much a plan as a wishcast.

Posted by: spotatl | September 22, 2009 2:00 PM | Report abuse

This series of delivery systems reports has been helpful. Of all the reports today, the Nichols remarks seem to be the least astute, which leads me to reconsider information offered by the New America Foundation.

The the previous report contained a comment from admitted partisan Harold Pollack "For now, the first strategy [aggressive government bargaining to CONSTRAIN PRICES AND UTILIZATION] seems out of reach. Democrats choose to blame insurance and pharmaceutical lobbies. In truth, the opposition is broader." which is is true. In contrast, not admittedly partisan Len Nichols elects to wag his finger, stomp his rhetorical feet, cry foul, and ignore fact and reality.

Perhaps additional admittedly partisan folks should comment more often.

Posted by: rmgregory | September 22, 2009 2:17 PM | Report abuse

It's not a plan but a tax increase that might do something someday.

Posted by: obrier2 | September 22, 2009 2:29 PM | Report abuse

I do think its pretty illustrative that all the posts Ezra has involve spending more money with the hope of someday lowering costs. Nothing that would actually lower costs.

Posted by: spotatl | September 22, 2009 3:01 PM | Report abuse

Wow, what a total surprise. It looks like Ezra managed only to ask lefty wonks about delivery system reforms. As rmgregroy said, Nichols had absolutely nothing of substance to add.

Posted by: novalfter | September 22, 2009 3:17 PM | Report abuse

All measures related to pilot projects and blue ribbon commissions should be stripped out of the bill, and then we can discuss health care reform on its own merits.

Posted by: bmull | September 22, 2009 4:13 PM | Report abuse

Ezra, you write "And in the meantime, you'll have the excise tax slowly bearing down on the system and making generous plans more expensive". Other than being an incentive toward adoption of less generous plans, how does this function to actually, dare I say it?, bend the curve? Does the tax put pressure on insurance companies, who then might try to put pressure on providers/pharmaceutical companies/etc? How?

Posted by: JonathanTE | September 22, 2009 4:44 PM | Report abuse

These are not plans, but the names of plans. This banal boilerplate is totally uninformative. I'm not complaining that it's boring, but that it contains no information.

Posted by: Ulium | September 22, 2009 6:59 PM | Report abuse

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