There are four pillars that, together, provide the foundation to Bending the Curve on health costs in the U.S.:
1. Invest in better information and tools (including incentives and comparative effectiveness).
2. Transition to accountable payment systems that reward lower-cost, higher quality care (i.e., make fee-for-service ‘less attractive over time’).
3. Restructure insurance markets to pool risk outside of employment and promote on quality and cost (including scaling back employer subsidies in favor of value-based benefit design).
4. Support and encourage better choices among health citizens (e.g., nudge through copays and tiering and measure outcomes along the way).
The ten experts who collaborated on this report’s recommendations range across the political spectrum, representing the American Enterprise Institute, RAND, Brookings, Harvard (both the University and the Medical School), and other academic institutions.
Health Populi’s Hot Points: In principle, I am in accord with these four pillars and, broadly speaking, the fine print tactics under each as enumerated in the report. There is some of this fine print, though, that will be difficult for certain stakeholder groups to swallow. Here are a few of those sticking points that could slow the rubber hitting the road…
Under Pillar #1: “Protect providers and insurers from liability when they follow best practices and implement safe systems, as identified by evidence.”
Under Pillar #2: “Increase payment rates for primary care, offset by reductions for specialty care.”
Under Pillar #3: “Cap the existing income tax exclusion for employer-provided insurance, to encourage carriers to design and workers to choose more cost-effective coverage.”
…and the big kahuna recommendation of them all,
Under Pillar #4: “Restructure Medicare Parts A and B with a global deductible and catastrophic out-of-pocket maximum.”
No surprise that not one of the 10 Gurus is an elected official…
But this is heavy lifting that’s cogent, smart, and well-informed. As Democrats and Republicans reconvene soon to arm-wrestle how to conserve costs in U.S. health care, they’d be wise to listen to this Gang of Ten.