Ronald Brownstein's Atlantic blog makes some points we all need to consider. It's becoming clear why the White House worked so closely with the Senate Finance Committee: they were working on health care cost and delivery issues that other committees declined to tackle.
Here's the link to Brownstein's blog: What Baucus Got Right. I'll try to summarize some of the more important points below.
Brownstein makes this summary point:
Baucus' draft bill offers the most fiscally sustainable framework yet devised for expanding coverage. It progresses much further than any other Congressional bill toward solving two fundamental and inter-related problems: creating a revenue stream that rises as fast as health care costs, and reshaping the incentives in the medical system in ways that should help "bend the curve" on those long-term cost increases. Without those two elements any coverage expansion will prove unaffordable, and thus unsustainable, over time. "Whatever its other pros and cons," said one senior Obama administration official integral to the health care debate, "the [Baucus] mark provides proof of concept that you can significantly expand coverage in a fiscally responsible way."
How does it do that?
1. It moves the system dramatically away from "pay per procedure" to "pay for results."
The bill represents by far the most serious effort to implement the innovative thinking from the community of health care reformers looking to move the medical system away from today's fee-for-service model toward a system that ties payments to providers to results for patients. It contains about a dozen major ideas-most of them implemented as national programs under Medicare, not merely as pilot projects-to nudge the medical system toward adopting the integrated models used by institutions such as the Cleveland and Mayo clinics and the Geisinger Health System to deliver high quality care at lower cost.
"You are not going to replicate Geisinger everywhere, but you can replicate their functions and that's what this bill is doing," says Kenneth Thorpe, chairman of the health policy department at Emory University's Rollins School of Public Health. "They are building many of the same payment and incentive models that you see in these integrated practices that have been very effective."
2. It encourages more coordination among providers.
It provides incentives (sharing in any savings) to nudge groups of providers to establish doctor-led "accountable care organizations" to more comprehensively manage patients' care under Medicare. More modestly, it funds a $500 million three-year test of "transitional care programs" designed to help hospital reduce readmission rates by providing more coordinated follow-up for patients after they leave the hospital.
3. It encourages innovation.
The bill creates two new institutions that could anchor the reform cause for years. Baucus would spend $1 billion a year to create an Innovation Center within the Health and Human Services Department that would fund a wide range of further experiments in coordinated care and payment reform.
4. It provides a mechanism for solving the political paralysis that keeps Medicare reform from happening.
The bill creates a second new institution that could be even more important: an independent Medicare Commission, as Obama has proposed. The commission would be required to offer proposals for cost-savings whenever Medicare spending rises too fast and Congress would be required to give their proposals fast-track consideration. The commission would likely become a vehicle to move into law the most promising payment and coordinated care reforms that emerge from the tests and pilot programs that the bill's other provisions set in motion. "If it develops into a respected independent body it could be one of the most significant parts of this legislation," said the senior administration officials. "I think that's the most auspicious path forward for promoting fundamental reform."
5. It creates large, long term, deficit reductions.
In its September 16 analysis of the proposal, CBO concluded that because Baucus' funding streams (like the provision taxing high-end health plans) are tied more directly to medical costs themselves, over the bill's second decade "the added revenues and cost savings are projected to grow more rapidly than the cost of the coverage expansion." So much faster that CBO concluded the Baucus bill over its second decade would reduce the federal budget deficit by as much as one half percentage point of GDP-a huge savings. "That's very important, and it is a significant departure from the previous bills," says McClellan.
6. It accomplishes near-universal coverage, affordably.
CBO concluded that the Baucus bill could move close to universal coverage (reaching 94 per cent of eligible Americans) with a funding stream that not only met the cost of expanding coverage, but also reduced the deficit. And even that conclusion doesn't include meaningful savings from the payment and care coordination reforms the bill embraces because CBO typically doesn't assume much impact from such dynamic proposals.
After all the screaming and name calling of the summer, it appears that the White House knew what it was doing when it worked so closely with Max Baucus for so long. Sen. Baucus has produced a liberal bill that makes the structural changes our delivery system needs so badly.