Editor in Chief,
Health Affairs and Health Policy Analyst, PBS
Prospects for healthcare reform and what they mean for industry. Difficult to predict what is going to happen (Yogi Berra – prediction is very hard particularly about the future.). Three weeks ago we thought we knew what the future of healthcare reform was. Then there was this little election in Mass. We are not “recalculating” what this means. Signs of recalculation:
Basics – why reform is necessary: (over 5,000 pages of legislation)
• President's 8 principles for health reform: premiums have more than doubled since 2000
• Health spending about 2% faster than overall GDP. If we manage to reduce to 1%….if at 2 percent, every additional dollar economy generates will go into healthcare.
• Reduce high administration costs, unnecessary tests and procedures.
• Got to take health insurance work for people who are insured; get rid of preexisting condition restrictions.
• 30 million people can’t afford to buy insurance (8 out of 10 are working)
• Individual mandate – everyone has to participate in pool. System only works if everybody is paying in. Penalty if you don’t pay in but can appeal, example Christian Scientists. 96 percent of legal residents covered by 2019; about 6 million Americans would not be covered.
What do we need to do?
• Need to beef up healthcare workforce. Lots of pieces in legislation that will do that.
• Transparency: Anything more than $5 will have to be reported electronically.
• Comparative effectiveness research: need to do better job in figuring out how interventions compare, e.g., drug-based versus surgery
• Prevention and wellness. Senate bill. First time ever to have national strategy to improve nation’s health.
• Medicare payment changes. Senate bill will have changes in Medicare program.
• Costs of the different bills proposed by Congress: Bills will pay for themselves.
• Some of the unresolved issues: elective abortions, undocumented immigrants, Medicare physician fee cuts