Friday, November 13, 2009

The Core Issues in Health Reform

Want a short summary cheat sheet of the core issues that are likely to be included in the final version of health care reform? Thank Paul Ginsberg's short article in the New England Journal of Medicine. Thank the Disease Management Care Blog for giving you an even shorter summary:

1. Expansion of the number of people with insurance: likely to turn out to be a blend of Medicaid and private market subsidies. All that remains is reconciling the more conservative fiscal considerations of the Senate versus the more generous House version.

2. Individual and small market insurance reform: look for 'actuarially equivalent' insurance options being offered through state exchanges with guaranteed issue and a coverage mandate. Right now, our elected representatives are hard at work reconciling that mandate with the level of insurance subsidies: the tougher the penalties, the higher the subsidy.

3. Purchasing of 'high value' care: the Achilles Heel in all this is the risk that health care efficiency will be increased by sacrificing quality. Time will tell if new versions of capitation, payments per episodes, efforts to reduce Congressional meddling, support for health information technology, comparative effectiveness research and prevention will pay off in bending the curve.

4. Tax increases: right now it looks as if there will be a combination of tax increases for high income individuals (the House version) and taxing high end health insurance policies (the Senate version).

Two other points:
Senator Harry Reid (D-NV) has definitely signalled that the Senate may not pass a bill until after Christmas. This may reduce the prognosis for health care reform, but the Disease Management Care Blog doesn't think that will be a lot.

While it will be up to the Conference Committee to reconcile the House and Senate versions and finally give the DMCB a likely description of what health reform will really look like, much important work will need to be done in writing the regulations, creating the organizations and writing legislation to deal with unforeseen consequences.

In other words, if health reform passes, the real work will have only just begun.

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