Looking Beyond the Public Plan Debate Toward Real Reform

Everyone agrees that the nation's health care system is broken. Our patchwork insurance system gives health care providers the wrong financial incentives. Meaningful reform requires a complete overhaul.

Many suggest the solution is as simple as crafting a public plan that competes with private insurers. While there are stark differences in how people envision a public plan, neither of the two major proposals goes far enough to transform the delivery system, improve quality of care, lower costs, and expand choice.

We should create a major risk pool that allows plans to seek out -- not avoid -- people with health problems. This will eliminate wasteful underwriting and selective marketing costs.

This risk pool should be publically chartered and operate independently, much like the Federal Reserve. It should be free from both the Congressional and Executive branch control so it is not influenced by special interest groups. Medicare's inability to do logical things ranging from competitive bidding for wheelchairs to increasing payments for primary care illustrates how vested interests can stymie change.

Pooling risk is necessary, but not sufficient to achieve meaningful health care reform. The risk pool will use new ways to pay the providers so the actual delivery of health care can be transformed. These new mechanisms do not merely cut costs, like capping fees. Instead, new payment approaches can improve health care quality by paying providers for engaging in team-based care or rewarding health care innovation on the ground.

More details on how a risk pool can transform the delivery of health through payment reform can be found in a blog post available now at Health Affairs. The complete white paper detailing this solution can be found here: "Beyond the Public Plan Debate: A Pathway to Transform the Delivery System."

Comments

[UninsuredGuy]

I don't have health insurance right now, but prescription costs have become increasingly difficult to manage. I started saving by switching to generic drugs by using Medtipster.

[RoloTomassi]

Any suggested reform that includes healthcare insurers is NOT worth serious consideration, so this article is a complete waste of space.

Healthcare reform--real, universal healthcare for everyone--is all that is worth doing, and not in some absurd privatized risk pool insurance-based scam; I'm sure it would transform US healthcare, and in a very negative way. No positive, cost effective healthcare program is even remotely possible as long as the status quo healthcare insurers are involved.

That bit of nonsense cleared up, it is fair to estimate that no significant healthcare reform will be forthcoming from the Obama administration; what he will do push and pass a hodge-podge mess of reform that will complicate the situation rather than have any positive impact.

Single-payer is the ONLY viable option, and that is clearly not being taken seriously.

[UncommonSenz]

"Single-payer is the ONLY viable option, and that is clearly not being taken seriously.­"

It is NOT the only option. People like you say that (repeatedly), but that ignores reality. France has a pretty good system, which does not involve single payer. Locking yourself into one solution while not even looking at the rest is an intellectually dishonest and lazy way to address one of the most complex problems of our time.

Regardless of if single payer is or is not the best option, it cannot pass right now. Period. The public option will have enough trouble getting through as-is, but single payer is dead on arrival.

The public option, however, would be the first step (and a pre-requisite) for ultimately passing single payer. But saying "single payer now or nothing" over and over and over and over again will mean we sit in EXACTLY the same boat, without ever moving forward. By doing that, and helping to sabotage ANY progress (because you can't stand not getting everything you want right away) you do as much damage as those who fight any change at all.

[RoloTomassi]

I am quite aware of France's system, and have the same opinion of it; that said, when have you EVER heard a non-profit insurer plan seriously discussed in the US?

IN context my friend; I am not ignorant of the many options, but single-payer is the only viable option in the US that current has enough support to even deserve a place at the talbe, if one makes that distinction by what is plausible through popular support.

Non-profit insurance in the US to replace the current model is NOT a viable option, at least not at the moment.

[Merlin7]

And if we clap our hands really hard, Tinkerbell will recover and fly away . . .
Seriously, it's pretty obvious that the proposed health care reform will be mainly about using tax money to further reward the corrupt establishment rather than actually helping middle class Americans. But then that applies to just about every issue nowadays, doesn't it?

[humanbeinghuman]

well said.