My biggest problem with all the bills floating around was that I thought they had no plans for cutting health-care costs. Insuring everyone and creating stability for those already insured is nice - but those things do not really matter if the government defaults on its health-care obligations.
Now I’ve read an article that has me convinced that the Senate bill does have a plan to cut costs, and it’s a plan that might actually work. The article is by Atul Gawande of the New Yorker. For those that don’t know Gawande, I suggest reading some of his other articles. The man knows how to write about medicine.
So here is the breakdown. The Senate bill plans to cut costs with pilot programs. There is not much else. Every major suggestion from health-care experts for cutting costs (except malpractice reform) was put into a pilot program. The theory is that health-care costs are up because health-care providers do not want to try anything new that will lower costs. Unfettered capitalism does not work if businesses do not know the best choices to make. So the way to help them is to force some of them to try new things. The hope is that if one of the pilot programs starts to work, its methods will start being employed voluntarily by other health-care providers.
For a description of some of the programs you can read the article. Some of the programs for Medicare and Medicaid are just experiments that the government will monitor to see if any will work. Other programs make insurance companies or health-care providers try new things in order to gain evidence of what works or not.
Left to their own devices health-care providers have been too timid to cut costs. Most likely because their customers are insurance companies rather than patients. However, if they see something that works, like one of the Senate Bill’s pilot programs, then they won’t be shy to adopt it.
This is the grand plan to lower costs. There is little else, besides a possible public option that - if it ever makes its way into a bill - will not do a lot to lower costs. It still relies on a government insurance company to lower costs by negotiating with health-care providers, when neither medicare nor medicaid have been all that successful.
What does everyone else think? Will this work?