Addressing Medical Costs

The Patient Protection and Affordable Care Act has lots of what can objectively be called “patient protections” – at least if one defines “health insurance policyholders” as patients. There’s restrictions on rescissions, increased policy transparency, improved preventive coverage, etc. And there are provisions aimed at addressing the cost of coverage: the medical loss ratio requirement and a host of pilot projects (I’ve promised a list of these and I’ll deliver a post on these cost containment items when I have the time to dig into the deeper crevices of the legislation).  But most objective observers – and quite a few of the more biased ones – will agree that the PPACA focuses more on health insurance reform than health care reform.

Yet making health care (not just health insurance, but medical services) more affordable was a major impetus for reform. The failure to boldly and visibly address this issue is one reason so many Americans are disappointed with the new health care reform law. Not surprising then that the itch, having failed to be scratched, is gaining increased attention. Alex MacGillis, in an opinion piece in the Washington Post, discusses the perceived failure of the PPACA to address “the price problem. He describes how the law focused on reducing the amount of unnecessary care that is delivered as opposed to directly dealing with the price of medical services.  And ends with the thought that “there may be support for tougher action on high prices once the principle of universal health coverage is established.”

Meanwhile, at the Brookings Institute’s Engelberg Center for Health Reform, a report entitled “Bending the Curve Through Health Reform Implementation” has been released. The report was written by a bi-partisan group that includes former WellPoint CEO Leonard Schaeffer. They offered three opportunities created by the PPACA:

  1. Speed payment reforms away from tradition volume-based payment system to better align them with quality and efficiency.
  2. Implement the insurance reforms in the PPACA, including the exchanges, to reward Americans when they choose higher quality care at lower premiums
  3. Reform coverage to empower Americans to save money and obtain other benefits when they make decisions that improve their health and reduce costs.

The report analyzes which of the numerous actions they call for can be done administratively under the new health care reform law and which would require additional legislation. The recommendations contained in the report are important and useful. Even more important than the specifics, however, is the non-partisan context they create on the issue of restraining skyrocketing medical costs.

When a new Congress reconvenes there’s going to be an initial flurry of political maneuvering to repeal, refine and/or gut the Patient Protection and Affordable Care Act. As I wrote in my last post, this is both a necessary and inevitable process. The news shows, like moths, will be drawn to where the most light and heat exists. And there will be plenty of heat. Hopefully, while the partisan battle rages, a few lawmakers will find the space to focus on meaningful public policy to move forward with initiatives that have the potential to meaningfully reduce the cost of medical care.

One can only hope.