I have received two comments regarding the recent health care legislation. The one I just approved, from Congressman Chris Murphy, is obviously thoughtful and took considerable time and effort to draft. I have some reactions to that comment, as well as the comment received earlier in the week, but I will be deferring response to both comments until this weekend, when I am back home and have an opportunity to look at some research I have accumulated on health care. I am honored that Congressman Murphy, a thoughtful and dedicated public servant, considered this blog of sufficient value that he would make the effort to comment. I owe him and all of you reading this blog a better effort than I can make from my hotel room after a lengthy conference.
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March 31st, 2010 at 5:06 pm
Mike – do you think the pilot programs referenced by Congressman Murphy that are included in the Act to change Medicare payment systems will have any significant impact? The Act does establish a 15-member
Independent Payment Advisory Board to examine cost containment and quality improvements within Medicare. The commission includes health care providers, consumer groups and researchers but does not call for any employer representation. The Commission is to present ideas to improve the quality of Medicare and to reduce beneficiary costs, but prohibits ideas that would “ration care, raise
taxes or beneficiary premiums, or change Medicare benefit, eligibility, or cost-sharing standards.” The Board is required to send proposals to the President and Congress at the same time. When Medicare costs are projected to be unsustainable, the Board’s proposals are to take effect unless Congress passes an alternative measure that achieves similar
savings. While I believe the goals to reduce costs are laudable, I am concerned that the limitations placed on the Board once again fail to permit the key ways to control costs (including rationing) and that the “unsustainable” standard reqires no action until too late.
March 31st, 2010 at 10:32 pm
I do not know whether these programs will be effective. There are two different questions: first, will HHS implement changed payment programs; and will these programs fundamentally change how health care is delivered?
At first glance, the assumption in the legislation is that if we change how health care is paid for, there will be substantive change in delivery and quality. However, if the result of payment and regulatory restructuring is that significant parts of the system would not be compliant, and those parts are major sources of jobs, the track record of elected officials in allowing government payment systems and regulations to cause significant job reductions, especially in dying communities, is not very good. To make this framework succeed as lawmakers like Congressman Murphy hope requires a level of political will we have never seen on a sustained level in this country.
The political skills required in navigating through all the consequences of this legislation are enormous, and it will take many morally courageous politicians to act together to make these changes effective.