If you are keeping up and are reading this because you want to know what I’m paying attention to (as if you don’t already know), here’s an extract of the MacGillis piece on costs:
What is unclear is if the proposals would achieve long-term savings. Reformers tout a new federal effort to determine, with the help of computerized records, the “comparative effectiveness” of treatments. But they say this effort would not take cost into account or issue firm guidelines over what to cover — assurances made, in part, to avoid upsetting providers and patients groups. End-of-life care eats up a huge slice of spending, but the proposals do little to address this directly. And the clause in the House bill about providing Medicare reimbursements to doctors for counsel on end-of-life questions originated in an earlier proposal backed by Republican senators.
Similarly, the bills call for empowering a federal panel to set Medicare rates free of pressure from providers, and for programs to test payment models that emphasize the quality of care instead of the quantity of treatments delivered. But these steps may not be enough to bring about the change that many experts urge — away from a system in which we pay for every MRI or drug infusion on a case-by-case basis, and toward one in which salaried medical professionals are paid to do what it takes to keep us healthy.
MacGillis is right to hedge. There are “cost curve bending” measures in the legislation but nobody can say for sure they’ll all work. In large part that’s due to special interest politics, which MacGillis acknowledges directly. Therefore, his summary is not just of the health reform legislation being considered today, but foreshadows the next battleground: costs.