Too Hot for Health-Care Reform
The Brookings Institution got a lot of press last week for a report on bending the cost curve on health care. David Brooks used his column in the New York Times to ask Obama to read it. The implication was that this report was too radical, too transformative, too hot for the political debate. It's "politically risky," warned Brooks, but it's the essence of change.
But actually, it's a reminder that many of the promising ideas on cost control are small, technocratic tweaks that haven't been anywhere near the center of the conversation. "Align Medicare payments to better support the use of allied health professionals," for instance. Or "increase payment rates for primary care, off-set by reductions for specialty care." Or "restructure non-group and small-group markets around an Exchange model that promotes competition on cost reduction and quality improvement." Nothing in there is a Big Idea. It's all small stuff, a vision of savings that would amass through the accretion of unnoticed efficiencies.
And much of it exists in the current bills. Max Baucus's framework, for instance, proposes that "primary care practitioners, as well as general surgeons practicing in a health professional shortage area, would receive a 10% Medicare payment bonus for five years. Half of the cost of the bonuses would be offset through an across-the-board reduction in all other services of approximately 0.5%." Elsewhere, "a percentage of hospital payment would be tied to hospital performance on quality measures related to common and high-cost conditions, such as cardiac, surgical and pneumonia care."
There's pages and pages of this stuff in there. Small changes to the delivery system and the reimbursement rates and payment incentives that are getting very little attention. This stuff, no less than the public plan or the treatment of immigrants, is the meat of health-care reform. It doesn't have a constituency, and it doesn't get much attention on the shows, but it accounts for the bulk of the pages in the legislation, and much of the savings -- not to mention quality improvements -- we're likely to see.
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