In September of 2009 the Brookings Institute issued a study entitled "Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth." I apologize for overlooking this report until now. The recommendations from the report are set forth below.
It has been estimated that the Democratic bills pending before the House and Senate will extend quality health insurance coverage to millions of Americans who are currently uninsured or underinsured and will reduce the federal deficit, but the Democratic plans will do nothing to limit the growth in the overall cost of medical care, which is expected to double over the next ten years. The Republican plan will do almost nothing to help the uninsured and underinsured, and it will have only a slight effect on containing costs – it is estimated that instead of doubling over the next ten years, under the Republican plan costs will go up by "only" 90%.
I support the Democratic bills because they achieve two of the three principal goals that any plan for reform must address – increasing access while maintaining quality. But the third goal – overall cost containment – is not achieved by either of the Democratic bills or the Republican bill.
In August of 2009 the Brookings Institute prepared a report entitled "Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth." This eleven-page report was released September 1. The report sets forth four general goals as well as a number of specific strategies for achieving each goal. Here are the four general goals and a brief description of each one in language taken from the report:
1. Building the Necessary Foundation for Cost Containment and Value-Based Care
As an essential foundation for reform, constraining spending growth while improving value requires information and tools like health information technology (IT) systems.
2. Reforming Provider Payment Systems to Create Accountability for Lower-Cost, High-Quality Care
Fundamental change is needed through a timely transition to new payment systems that have accountability for reducing costs and increasing quality, reinforced by increasing pressure to make fee-for-service less attractive over time.
3. Improving Health Insurance Markets
Governments should ensure proper incentives for non-group and small-group health insurance markets to focus on competition based on cost and quality rather than selection. Achieving this requires near-universal coverage and insurance exchanges to pool risk outside of employment, augment choice, and align premium differences with differences in plan costs. Existing inefficient subsidies for employer-provided insurance and overpayments for Medicare Advantage should also be reformed to improve incentives for lowering costs.
4. Supporting Better Individual Choices
Individuals need support for making better choices as patients and consumers — choices that enable them to get better care and stay healthier at a lower cost.
On September 29 of this year Brookings issued a related report assessing the extent to which the Senate Finance Committee bill had followed the recommendations of the August, 2009, study by the Brookings Institute. This second report is entitled "Bending the Curve: A Comparative Review of the Senate Finance Committee Reform Proposal."
Over the next week I will describe the specific reforms proposed in the Brookings Institute's initial report and, drawing upon the second Brookings report, I will attempt to assess the extent to which the three proffered bills – the House Democratic plan (the Affordable Health Choices Act of 2009, H.R. 3962), the House Republican bill (the Common Sense Health Care Reform and Affordability Act), and the Senate Democratic Plan (the Patient Protection and Affordable Health Care Act), comport with the recommendations of the Brookings Institute.
Visit Professor Huhn's website on health care financing reform for links to information about proposed legislation, studies and reports, public agencies, and private organizations concerned with this issue.
