As expected, the House took the first swing last weekend at passing a plan to overhaul the nation's health care system. The bill includes some long-needed reforms, such as preventing insurers from turning down patients with pre-existing conditions. But it misses the mark in numerous other ways, including the risk the proposal poses to the deficit over the next two decades.
The House plan will not be the final bill, of course, and that's a good thing. We all should hope that moderate Democratic senators amend the final product so that it can better contain health costs.
The Peter G. Peterson Foundation recently analyzed the Senate's bill and concluded that it falls way short in curbing medical expenses. For example, the foundation discovered that:
"Without providing new measures to control the growth in costs, total health spending would rise from about 17 percent of gross domestic product in 2010 to 25 percent in 2029."
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Equally troubling, the foundation reported that: "The federal government's health spending would increase by almost $400 billion over the next 10 years and $1.6 trillion over the 20-year period."
So, what to do? How can the Senate ride to the rescue and better "bend the cost curve"?
Here is one big way: Change how doctors and hospitals are paid. Like the House bill, the Senate plan still relies on limiting payments to doctors and hospitals to curb health spending. Such payment limits have not worked in the past. Doctors have balked and, generally, Congress has suspended the reductions. There's no reason to think things will be different in the future.
Instead, Congress should create a Medicare payment system that rewards doctors and hospitals for using data, patterns and evidence that point to the best way to treat their patients. "Evidence-based medicine" will never be perfect, but it could improve the quality of care that patients receive by regularly tracking patient outcomes. Instead of just rewarding medical providers for the volume of services they provide, which we do today, the feds — and private insurers — should reward them based on their results.
A change like this can't happen overnight. But the Senate can move us further toward this goal. For example, the Senate needs to create more pilot programs that reward doctors and hospitals for keeping patients healthy, not just giving them treatments.
There are hospitals trying to think anew about how they deliver care. The New York Times' David Leonhardt profiled Utah's Intermountain Healthcare, citing how it is using evidence-based medicine to change practices, such as how the hospital treats early births.
But we still have a system that is built upon fee-for-service medicine. And that's a big part of our problem. As Leonhardt wrote:
"The fee-for-service payment system encourages ever more testing and treatments. We're not sure which ones make a difference, but we keep on getting them, and costs keep rising. Millions of people cannot afford insurance as a result. Millions more have had their incomes pinched by rising insurance premiums. Medicare is on a long-term path to insolvency. The American health care system is vastly more expensive than any other country's, but our results are not vastly better."
Change won't come until Congress puts its weight behind this shift in approaching medical care. If the goal is to systemically reform our health care system, this is one crucial part of the current system we can't leave out.