Another Tired View of Fixing the Health System

Former senators Tom Daschle, Pete Domenici, Bill Frist and former Budget Director Alice Rivlin formed the Bipartisan Policy Center Health Care Cost Containment Initiative, a worthy effort to find solutions to health care quality and spending problems that avoid political posturing.  Unfortunately, the solutions they are putting forward don’t really add anything new to the ongoing discussions, as reflected in a New England Journal of Medicine article.   (NEJM Article)   Their vision is off a system that is “value-driven and coordinated”.  They believe that their recommendations would save $560 billion over ten years, including $300 billion for Medicare.  They offer four core recommendations: improve and enhance Medicare; reform tax policy; prioritize quality, wellness and prevention and encourage and empower states.  In terms of Medicare, they suggest moving beyond ACOs to “Medicare Networks” and to moving to new reimbursement methods, particularly for physicians.  They also propose tinkering with the benefit structure to provide incentives for beneficiaries to avoid low-value care.  In regard to taxes, they suggest repealing the “cadillac” tax and replacing it with a limit on the income-tax exclusion for employer health care.  They want to improve the use of quality measures, increase efforts to prevent poor health and continue to focus on workplace wellness programs.  And empowering states means having a dual eligible program for Medicare and Medicaid recipients.  It is not that these ideas and proposals are bad; just that they seem like more of the same, with few specifics of policy and program changes.  And it is not clear that the real source causes of poor health, poor care outcomes and higher than necessary spending are being addressed.