Evaluating the President’s Speech Tonight in Terms of ‘Effectiveness as True Reform’

By Sadie Bass

Sep 9, 2009 5:22pm

ABC's Chief Medical Editor Dr. Timothy Johnson reports:

There are three standard criteria for evaluating Health Care Reform (HCR) proposals:
1) Increased/Improved Insurance Coverage: This is the politically easiest to do — the idea of improving existing insurance (getting rid of problems such as pre-existing exclusions, etc) is popular and the insurance industry has basically already agreed to it in exchange for mandatory coverage provisions which will give them more (mostly healthy) customers to offset the increased costs of reform. The hard part is in working out the details of mandates and how to pay for the needed subsidies for lower income customers. Another feature sure to be proposed tonight is an Insurance Exchange where customers (individuals and small businesses) can go to more easily choose insurance; the details to look for include whether a "public option" is part of the exchange, will it be a federal exchange or state exchanges or some combination, how will this/these exchanges be regulated, etc. P.S. You can have a very effective health care system (e.g. Germany, Switzerland) without a public option if the government strongly regulates the private insurance industry, as they do in these and most other developed countries.
2) Increased Quality: This is much more complicated and ideally requires many tools we do not yet widely have — such as electronic records, vastly increase primary care resources, comparative data to determine what works best, etc. All of these improvements require significant up front funds and significant changes in current medical practice patterns and policies. But simply increasing coverage without providing these features is not true reform — only the expansion of the present broken non-system.
3) Controlling Costs: I deliberately use the word "controlling" vs. "decreasing/lowering" costs. Nobody pretends that true reform will actually lower costs from current levels. Indeed, as you well know, the estimates for increased start up costs over the next ten years range from $1-2 trillion, even though current proposals are struggling to come in under $1 trillion. The real goal is to "bend the curve" — i.e. slow down the dramatic rate of inflation in health care costs — about 7-8% per year over the last decade. Quite frankly, this will never happen until the tools mention in section 2 are in place — comparative data to identify what is cost effective, primary care to direct and control care, electronic records to make it more efficient, changing patterns of compensation to outcomes rather than simply doing more tests, procedures, etc.
Bottom Line: Any plan that talks about increasing Coverage without providing details about Quality and Costs is not true reform.

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