To my surprise, my latest Kaiser Health News column appeared this afternoon. (I was expecting it tomorrow.) It begins,
Let’s be honest. We really don’t know what’s going to control health care costs, long term. Today’s politically winning idea could be tomorrow’s platter of humble pie.
There are lots of different thoughts about how best to do it. But which of them deserve political and legislative support?
It goes on to recount the history of public and private sector failures to control health care costs and what that means for the future. Read the whole thing here.
It does make me sound like a pessimist. I’m not. I’m just a realist, and I know how hard it is to reduce health care cost growth.
Having said that, I think ACOs, the excise (Cadillac) tax, and the IPAB are very promising ideas. ACOs are not merely a public-sector idea, though they’ll likely be more broadly tested in public programs before they grow in the private market. Nevertheless, ACO-like payment arrangements can, and probably should, be implemented by private insurers and they can be integrated with more market-based insurance concepts. The excise tax is the only provision of the ACA directly aimed at private-side costs. So, it’s critical, but I expect there will be calls to delay it or water it down. The IPAB is purely a way to get around the political challenges of necessary reform of Medicare. It’s a good idea, and I’ve heard no convincing argument against it.
So, I’m optimistic about these ideas. But, politics being what it is, I would not be shocked if none of these worked or were allowed to work. In particular, I discussed how ACOs could fail in a recent post.