Delivery System Day: Harold Pollack
Harold 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.
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