Cost control issues take center stage in health care reform

Cost issues continue to receive attention as bipartisan support emerges on the Hill for a commission to control health care costs. Kaiser Health News reports: "The drive on Capitol Hill to create a bipartisan entitlement and tax reform commission to help 'bend the cost curve' of health spending and address mounting deficits picked up momentum yesterday, as Senate Minority Leader Mitch McConnell and a handful of moderate Democrats and Republicans voiced support for the effort. The commission would draft proposals to control the long-term costs of Medicare, Medicaid and Social Security, which together account for 40 percent of all federal spending other than interest on the debt. The recommendations would require a swift up or down vote by a supermajority of members of Congress, to assure bipartisan support for unpopular measures to cut sensitive spending programs or to raise taxes if necessary."

The measure's chief architects, "Senate Budget Committee Chairman Kent Conrad, D-N.D., and Republican Sen. Judd Gregg of New Hampshire, say they will attempt to attach their plan to must-pass legislation raising the government's debt ceiling in the coming weeks. ... McConnell, R-Ky., said he would have to see the composition and mandate of a commission before signing on, to make sure Republicans were adequately represented. But his comments echoed those of Conrad and others who believe a commission may be the only way to force Congress to come to grips with unsustainable spending on entitlement programs, the major cost drivers in the federal budget. ... The government is on track to accumulate deficits totaling $9 trillion between now and 2019, according to the Treasury and the Office of Management and Budget. ... Experts say that these problems are not being addressed as part of the health care overhaul bill passed by the House last weekend or the plans being considered in the Senate" (Pianin, 11/11).

On the News Hour, Judy Woodruff interviews Peter Orszag, director of the White House's Office of Management and Budget, who says premiums "will go down" under the health bill (Woodruff, 11/10).
In a separate segment on the News Hour, Woodruff interviews Gail Wilensky, a former administrator of the federal Medicare program, to examine whether health care reform can change the system and cut costs. Wilensky describes her two wish list items to control costs, the tax treatment of high-cost Cadillac plans and pilot programs.

Wilensky says: "'It's absolutely true we don't know how to get from a -- a system where most physicians are paid on a fee-for-service basis, each individual service that's provided, to paying for taking care of somebody with diabetes, or to pay all the physicians that take care of somebody who is having a bypass procedure or a hip replacement. That's called a bundled payment. We need to experiment how to do it. But our history with pilots is that, if there is not the authority up front to implement the pilots that work, they're not likely to actually find their way into action. And that's a big problem'" (Woodruff, 11/10).

The Wall Street Journal reports on Congress' history of reversing Medicare cuts and notes: "That history shows why some critics believe billions of dollars in budget savings Congress is promising through its health-care overhaul might never materialize. Under both Democrats and Republicans, Congress repeatedly has waived curbs it has tried to place on spending" (McKinnon, 11/11).

Meanwhile, The New York Times column "The Economic Scene" explores why the House bill fails to live up to its goals. It is "important to step back and understand precisely what health experts mean when they argue for reforming the delivery system. It is not simply about bending the curve, or slowing the growth, of Medicare's projected spending. ... Making the medical system more efficient is, in short, about saving lives and giving Americans a long overdue raise. It is arguably the single most important step that the federal government could take to improve people's lives. And the bill that the House of Representatives passed last weekend simply does not get it done" (Leonhardt, 11/10).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.