Wednesday, April 22, 2009

Health Care Reform: A Readable Summary from the New England Journal of Medicine

Today's New England Journal of Medicine has a brief and readable summary that describes the status of D.C.'s health reform efforts.

As you are reading this, there are 3 House committees and 2 Senate committees that are meeting behind closed doors trying to hammer out some legislation. Each of the committees will generate similar 'harmonized' proposals within their respective areas of jurisdiction. Based on what is known about the discussions that are underway, we can already begin to discern what kind of bill will emerge this summer.

Elements include an insurance mandate (with a tax penalty for those who don't cooperate), premium subsidies for the poor, changing eligibility criteria for Medicaid, strengthening SCHIP (the Children's Health Insurance Program), bundling payments around episodes of care, promotion of 'accountable care organizations,' supporting the medical home, capping the deductability of employer-based health insurance (which would generate some money to help pay for it all), malpractice reform, pursuit of fraud, reduction of waste and creation of a public plan. This last issue is proving to be the most contentious and may prove to be the flash point between social conservatives and liberals.

The Disease Management Care Blog has previously come out in support of bundled payments as a means of promoting efficiency. It also believes that if the payment is done right, physicians and hospitals will start to become aligned without having to craft additional legislation.

As for the medical home, the DMCB notes that Phase II of the Medicare Electronic Health Records Demonstration was cancelled following passage of the American Recovery and Reinvestment Act (ARRA). Is the same fate looming for the Medicare Medical Home Demo? If Congress passes a bill that fully underwrites the Medical Home in fee for service Medicare, why would a demo be necessary?

Last but not least, the DMCB is less aware of the art of bipartisan compromise over the issue of a public plan, but it knows that the definition of a public plan may be the route to some sort of agreement. For example, it might be possible to create a public option that is funnelled through a private insurance mechanism, acts as an insurer of last resort and is backed by regulations with teeth.

And all those community meetings over the winter and the public discussions and roundtables over the spring? Thanks to all of you for your efforts, but we know those events had a far different purpose. The real decisions are now being made behind closed doors. Our job as citizens will be to wait and see what emerges - and to carefully read the fine print for all those important details.

The DMCB is looking forward to it.

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