03/18/2010 05:12 am ET Updated May 25, 2011

The Senate Bill and Cost Control

Among people who are in favor of reforming the health care system there are two dominant camps: those who prioritize access and those who prioritize cost control. Both groups generally want increased access and reining in of health care costs, and they're even happy to get improvements in quality along the way.

They differ on which problem they think should be tackled first. One group says, "Get everyone in the system first. Then we'll control costs." The other group says, "Control costs now. Then use the savings to expand access to others." There are good arguments to be made for each approach, but most people agree that the Senate bill does much more to increase access than it does to control health care costs.

In fact, this is one of the leading criticisms of the bill from both sides of the aisle. The problem is that there's no magic bullet for controlling health care costs. If there were, you'd hope that we would have already loaded it into the policy gun and pulled the trigger long ago. Instead, we have ideas. And when I say "we," I mean the economists, health services researchers, and others who study the health care system for a living to better understand how it works and how to improve it. I am one of those people-in-training.

Ideas are potential solutions, but a pen-and-paper exercise can only carry us so far. We have to test the ideas out in the real world to see what happens. If the ideas don't work, we don't want them to be failures on a grand scale, so we test the ideas out on a very small scale at first before making a decision about expanding them. These are called demonstration projects, and they're a pretty sensible way of moving forward judiciously in my opinion. As Timothy Jost puts it in a post over on the Health Affairs blog:

"One of the most common complaints about the health reform legislation pending in Congress is that the bills do nothing to control the growth in health care costs or improve the quality of health care. Those who raise this complaint either have not read the bills or are very attached to a particular proposal that was somehow left out. This is not to say that the legislation will actually control costs or improve quality; it is simply to say that many, if not most, of the credible ideas that health policy analysts or economists have dreamed up over the past two decades for bending the cost growth curve or improving the quality of American health care are in the bills."

Demonstration projects. Taking baby steps to test ideas and divine the best path forward based on what works. It really seems ideal. The alternatives are either to do nothing at all--which promises to end in nightmarish fashion--or to pick just one or two major initiatives that are applied nationwide--and hope against all hope that they don't crash and burn.

The progressives, playing it safe. How deliciously ironic.

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