THE TREATMENT SEPTEMBER 18, 2009
Ron Brownstein does. No, he doesn't have a vote in Congress. But he's somebody to whom Congress listens--and rightly so. He is smart, careful, and happens to know a lot about health care.
So what has him so happy? The bill's attack on rising costs:
The bill represents by far the most serious effort to implement the innovative thinking from the community of health care reformers looking to move the medical system away from today's fee-for-service model toward a system that ties payments to providers to results for patients. It contains about a dozen major ideas-most of them implemented as national programs under Medicare, not merely as pilot projects-to nudge the medical system toward adopting the integrated models used by institutions such as the Cleveland and Mayo clinics and the Geisinger Health System to deliver high quality care at lower cost. ...
Mark McClellan, director of the Brookings Institution's Engelberg Center for Health Care Reform, and the former Medicare and Medicaid director under President Bush, was similarly impressed. While the Baucus proposal didn't move as boldly as McClellan would prefer on some fronts-like reforming medical liability laws-he said the plan substantially tracked the recommendations of a widely-praised bipartisan report that he recently released outlining strategies to slow long-term spending growth. "It does bend the [cost] curve in the long term," McClellan said. "They clearly are working hard to make fiscally responsible decisions about health care reform."
The senior administration official agreed, giving the plan an overall "a-minus" grade for structural long-term reform. "The big things are all there," said the official. ...
the Baucus bill incorporates most of the major ideas that reformers have offered to encourage long-term cost-savings in the medical system. Two common themes link these ideas: shifting the reimbursement model away from volume to value, and encouraging physicians to work more closely in teams to manage the overall health of patients, particularly those with expensive chronic conditions. The bill would implement these ideas within Medicare, though advocates hope that if these practices prove effective, private insurers will adopt hem as well.
Democrats paid a high price in lost political momentum for the three months this summer Baucus spent negotiating with Republicans. Those long discussions ultimately may not produce any Republican support. But the release of the Baucus bill makes clear that even if no Republican signs on, that time wasn't wasted. Despite all the vitriolic complaints from the left-Howard Dean is becoming living proof that health care reform should offer a universal entitlement to Valium-Baucus has advanced the historic Democratic cause of providing health security to all Americans by demonstrating that it can be compatible with fiscal responsibility and long-term cost control. Baucus, to say the least, hasn't solved the entire puzzle. Yet if his party is smart enough to recognize it, Baucus' innovative ideas on financing and structural reform could move Democrats substantially closer to a final plan that will not only reach President Obama's desk this year-but achieve lasting acceptance from the American public.
As I wrote last night, I think economic security as as important as controlling costs--and worry Congress won't give the former enough emphasis. But Brownstein is right about what's good in the Baucus bill.