As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Wednesday, April 29, 2009

Paying For Quality In Health Care, Not For Service

I just got off a conference call with Vice President Biden, where he stated clearly that health care was the number one priority for the Administration in the next 100 days. He believes there is a confluence of interests, from the business community to medical professionals to reform advocates, to get something done, and the recession is only increasing that pressure. Today we saw a bipratisan proposal from Sens. Baucus and Grassley to help clear the biggest hurdle in health care, namely how to pay for it.

Pushing to change how medicine is paid for as part of a sweeping overhaul of the nation's healthcare system, two leading senators offered a plan Tuesday to pay more to hospitals and doctors who meet federal quality standards and penalize those who do not [...]

The senators' 48-page memo is to be discussed today at a closed-door meeting of the finance panel. Although it does not lay out specific quality standards, the proposal reflects a consensus among policymakers and experts that the current system -- in which doctors largely are paid based on the number of services they offer -- has led to enormous waste and left Americans with poorer healthcare.

In addition to promoting quality standards, Baucus and Grassley have proposed pay incentives to encourage primary-care physicians to manage a Medicare patient's dealings with multiple providers.

And their memo suggests that the amount private insurers receive from the federal government for offering Medicare coverage to seniors could be linked to some quality measure.

It's my understanding that the public does not agree with this, so it'll take some selling. The public currently prefers fee-for-service and probably has been twisted by conservative misinformation to see payment based on federal standards as some kind of unnecessary intrusion into the private market (socialized medicine, oh noes!). But government has a role to play, especially if they are spending so much on health care, to try and bend the cost curve and improve efficiency. Ultimately, we don't know where the pot of money to pay for universal health care will come from - Vice President Biden said on the call that "we think they'll come back to the way we think it should be paid for" - but the benefits of increasing access and care pretty much universally outweigh the costs.

On the public-plan front, the President held a meeting with the House Progressive Caucus where he reiterated his support.

The message that they conveyed from their meeting is that the White House supports efforts for a public plan for insurance coverage when it comes to health care reform.

One of those members, speaking to the Huffington Post after the affair, summarized it like this: "The President told us we have his backing on a public plan." The obstacle, the member added, will come in Congress, where cobbling together the votes needed to pass a health care package with a public plan could be problematic.

Obama appears to have said "we're behind you, now go get it." Perhaps the strategy of agitating for single payer (a question about it came up on the Biden call), allowing the public plan to be part of a fallback option, will work. As Katie Robbins of Healthcare Now says, “The best way to get half the pie is ask for the whole pie.”

Related: where will we get the doctors to deal with all these newly-insured patients?

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