House Speaker Nancy Pelosi said today that the House cannot pass the Senate version of health reform without major modifications. She also stated that an option to consider is to return to the drawing boad. Her conciliatory tone without question, indicates that she is aware that the present health care refrom measures are all but 'dead'.
On Wednesday, President Obama reflected on the status of health care reform in light of the Scott Brown victory in Massachusetts. In an ABC interview, the President stated essentially that some elements of reform are still plausible and that Congress needs to work on crafting a bill containing these elements. The elements he referred to included banning insurance companies from using pre-existing conditions as part of underwriting, eliminating life-time maximums, and expanding government support so that people without insurance can buy or access the coverage they need. Effectively, President Obama indicated that reform, while still possible, was not possible in its present legislative form.
Being the policy and economics 'wonk' that I am, I thought it appropriate to give President Obama, Sen. Reid and Speaker Pelosi ten relatively easy steps that should be followed in order to get health care reform started. Of course, the first step is to avoid global legislative and policy endeavors. The mess that is health care in the U.S. today did not occur over night and it cannot be fixed by one 2,000 page piece of legislation. It can only be fixed over time, incrementally with one bill or piece of legislation leading to another.
I'd start with some simple, basic initiatives that make sense and will save money. These inititatives, although perhaps politically unpopular to some, are pre-requisites to getting the bigger stuff done later.
- Tort reform, nationwide. Savings are in the billions annually.
- Standardize a billing claim form and require that the same be used for all claims, regardless.
- Standardize or federalize, the rules for issuing health insurance for all 50 states and make health insurance portable across all 50 states.
- Reverse or at a minimum, freeze the issuance of new, federal mandates on insurance coverage. Stop doing dumb things that cost money such as the Mental Health Parity Act. If you are intent on saving money in the system, keeping mandates out of it will do just that.
- Increase immedately, grants and assistance for medical students that become primary care (Family Practice, Internal Medicine, Geriatricians, and Pediatricians) physicians in order to increase the supply. Until in the interim, the dynamics of cost of education versus revenue from practicing medicine change, the costs of education component can at least be changed. More primary care doctors saves the system money and improves overall access to preventative care.
- Create a national risk sharing pool for high cost cases or insureds and wrap the coverage around private insurance plans and Medicaid plans.
- Leave HSA plans alone. Nothing is more efficient in terms of saving money than consumers and their ability to measure their own risk and save their own money accordingly.
- Leave Medicare Choice plans alone. Frankly, the government should actively incent participation in these plans as they work. If you want to tinker with them because they are just too darn successful, create a simple bonus plan for high performing plans plus a risk share arrangement. In this manner, performance is rewarded (I know, this is an anathema in Washington) and sound risk management pracitces engaged.
Getting to the bigger stuff on Medicare and Medicaid will come next. Nothing like leaving some proverbial 'food' on the table for another article...