The best way to reform health care?

Over at the Daily Beast, Einer Elhague offers a column that promises the “best way to reform health care and cut the deficit.” It’s the “least painful way to lower health care costs” and bipartisan to boot.

Imagine my surprise when the idea is to issue more aggressive regulations supporting ACOs and IPAB, both in service of defragmentation.

Don’t get me wrong. I’m cautiously optimistic on ACOs in the long term, and a big fan of IPAB and defragmentation, but these aren’t new ideas. Both are found in the PPACA. And while ACOs have bipartisan support, the IPAB is one of the provisions Republicans hate most (which is saying a lot). One of the first actions taken by the House Republicans in the 113th Congress was to specifically promise not to follow the IPAB procedures.  Health policy wonks like Tim Jost have worried whether any of the 15 IPAB members will ever be confirmed by the Senate, which dims hopes for recruiting good people. Doesn’t get much less bipartisan than that.

As for ACOs, after a false start in March 2011, the feds issued a remarkable series of regulatory waivers in May 2011. These rules jumpstarted a surge in ACO development. But remember that early results from ACOs are more mixed than proponents would have liked, i.e., the empirical data on ACOs are still not clear, which gives me reason for caution, not doubling down. See our ACO tag for more.

So, I’d like to hear more details on:

  1. Precisely which pro-ACO regulations are needed, but have not been issued yet; and
  2. How IPAB will ever get Republican support.



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