“A Milestone in the Health Care Journey”

Last weekend, Ron Brownstein – a reporter for The Atlantic – wrote that the Senate’s health insurance reform legislation marks a “milestone in the health care journey.”

Brownstein spoke to several leading economists, including MIT health care economist Jonathan Gruber, who agreed that the Senate’s legislation is a major step toward ending the unsustainable growth of costs in our health care system.

Gruber, a self-proclaimed “skeptic on this stuff,” said: “Everything is in here....I can't think of anything I'd do that they are not doing in the bill.” Len Nichols of the non-partisan New America Foundation and Mark McClellan, the director of the Center for Medicare and Medicaid Services under George W. Bush, were also positive in their analysis of the bill.

Brownstein digs deep into Majority Leader Reid’s efforts to blend the Senate Finance Committee’s bill with the HELP Committee’s legislation and “bend the curve” by “shifting the medical payment system away from today's fee-for-service model toward an approach that more closely links compensation for providers to results for patients.”  The piece also highlights how Reid incorporated four measures identified in a letter from 20 leading economists to President Obama, that are essential to fiscally responsible health insurance reform.

We excerpted the article in the Morning News clips on Monday, but here’s a highlight in case you missed it. It’s worth the read:  

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won't succeed unless it "bends the curve" in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

"I'm sort of a known skeptic on this stuff," Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing…"

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn't able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. "One never knows whether we're turning the corner or if this is just playing the same old game for another inning," he says. "But I sense there's something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve." If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.