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Delivery System Day: Harold Pollack

Pollack_0811.0080_web.jpgHarold Pollack is a professor at the School of Social Service Administration at the University of Chicago, a faculty chair of the university's Center for Health Administration Studies, and a frequent contributor to the New Republic's Treatment blog. Folks who read him over there know he's not scared to call out opponents of reform. But the promise of delivery system reforms, says Pollack, is that there are fewer opponents, or at least the opposition isn't as ideological.

Successful cost control requires two strategies: (1) aggressive government bargaining to constrain prices and utilization, and (2) the development of new care models that provide more efficient care. For now, the first strategy seems out of reach. Democrats choose to blame insurance and pharmaceutical lobbies. In truth, the opposition is broader.

I am becoming more optimistic about the second strategy. I don’t know whether accountable care organizations or primary care medical homes really save money. No one else knows either, which has the unfortunate consequence that these efforts get snubbed in CBO scoring. If we are smart, we can find out.

I’m also struck that these efforts enjoy wide support among partisans who normally disagree. As a partisan myself, I have no trouble identifying friends and enemies in the fight over universal coverage. When I ponder delivery reform, I find the white hats and black hats more difficult to place. However liberal and conservative experts might disagree over the public option, both want to shift resources from specialty to primary care. Both want Medicare purchasing through competitive bidding. Both want medical care to be explicitly guided by comparative effectiveness research. When we get down to the fine print, the political economy of health care looms larger than partisan ideology.

I think there might be more agreement among experts on this stuff than there is among partisans. Comparative effectiveness, certainly, has been a football. But this is the upside to delivery system reforms being a bit obscure: Many of them can slip by unnoticed, as has happened in this debate. It's more of an elite conversation than, say, the public plan, and that means the elite unanimity mentioned by Pollack actually matters.

By Ezra Klein  |  September 22, 2009; 1:44 PM ET
Categories:  Health Reform  
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Next: Delivery System Day: Len Nichols


I'm even more optimistic: it's not that they slip by unnoticed. It's that most of these ideas are so common-sense. Saying you should change the oil in your car to save replacing the engine just isn't partisan, and setting up an incentive to do so isn't partisan.

Posted by: HalHorvath | September 22, 2009 2:05 PM | Report abuse

Delivery system reforms are just as controversial once you move out of the theoretical and into actual practice.

It was dumb to take government cost controls off the table. That's the low hanging fruit.

Posted by: bmull | September 22, 2009 4:23 PM | Report abuse

Good points, Dr. Pollack! I am very encouraged by the enthusiasm for delivery system reform being demonstrated at the highest levels of health care organizations around the country. There are at least two groups of CEOs that I know of, working to accelerate payment reforms and what they want to be accomplished is pretty widely shared across the aisle.

Posted by: LindaB1 | September 22, 2009 4:51 PM | Report abuse

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