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Can Bipartisan Healthcare Solutions Survive the Obamacare Backlash?

Hyper-Partisan Politics Surrounding Obamacare Suggest Not

Bipartisan Policy Center post-Obamacare report

Bipartisan Policy Center (Photo credit: Wikipedia)

The latest issue of The New England Journal of Medicine has an interesting post-Obamacare report from the Bipartisan Policy Center. It’s optimistically entitled “Prescription for Patient-Centered Care and Cost Containment”.

It’s optimistic because of the initial favorable responses it’s received from both sides of the political aisle. Its authors presume this presages a favorable bipartisan legislative response capturing its most salient measures to achieve the true healthcare reform to which Obamacare only opens the door.

While it’s possible it could be packaged for Republicans as fixing Obamacare’s flaws, that would require a sincere interest in doing just that. The endless symbolic House votes to repeal Obamacare, however, suggest otherwise.

House Majority Leader Eric Cantor (R – Va.) confirmed this with his comment just yesterday that “The best delay for Obamacare is a permanent one”.

Giving the President anything that could remotely be construed as enhancing his signature healthcare initiative just isn’t very likely in our super-charged political environment. There’s far greater interest in fabricating White House scandals than legitimately governing in the public interest.

Which is too bad, because the measures being proposed by this panel  – led by former legislators Tom Daschle, Pete Dominici and Dr. William Frist and former cabinet member and economist Alice Rivlin, PhD – represent a reasoned and balanced approach to picking up where Obamacare leaves off.

There is, after all, much work still to be done. Despite Obamcare, America’s healthcare system remains far from the efficient and effective vehicle for delivering healthcare – and maintaining health – that we need for our long-term fiscal and physical health as a nation (see Our Healthcare Sucks for more on this).

If only the Bipartisan Policy Center’s hard work to achieve that vision had even the slightest chance of seeing the legislative light of day.

What Are They Proposing?

Their complex set of proposals fall into three main categories: Medicare reforms, tax policy reforms, and prioritizing quality, prevention and wellness. Let’s take a quick look at what healthcare policy might look like if we were free of the political grandstanding that now dominates Washington politics to a degree unknown in our recent political history.

The Medicare reforms being proposed address all three major players – providers, insurers and beneficiaries/patients. The proposed reforms include improving on the Accountable Care Organization (ACO) model with so-called “Medicare Networks“. These would replace the much-maligned Sustainable Growth Rate (SGR) formula for Medicare payments to doctors with an improved fee-for-service payment system.

Replacing fee-for-service payments altogether should be the ultimate goal for rationalizing our healthcare system. Removing its incentives to perform more medical interventions than are needed is the best course to reduce the third or more of our healthcare costs that serve no legitimate purpose. The Bipartisan Policy Center’s suggestions, however, may be the next best thing.

In short, they’d significantly improve the current fee-for-service system by increasing competitive bidding, bundling services, and increasing accountability and affordability through their proposed Medicare Networks. Medicare beneficiaries would get reduced premiums for joining such coordinated networks, sharing in the savings with their medical providers. Current Medicare fee-for-service payments would be frozen to motivate doctors and hospitals to participate in the new Medicare Networks.

The entirely reasonable premise behind this approach is that better, more coordinated care will reduce healthcare spending growth – much of which is due to our current disorganized and highly fragmented delivery system.

A second Medicare reform would increase competitive bidding among Medicare Advantage insurance plans. Rather than their current focus on adding extra benefits that increase costs, insurers would bid on standard Medicare benefit packages based solely on price. This would be phased in over time to protect beneficiaries from any abuses that might otherwise ensue during such a transition to a more value-driven insurance model.

A third set of Medicare reforms would rationalize beneficiaries’ Medicare coverage. These would reduce subsidies for high-income beneficiaries while enhancing them for low-income beneficiaries. They’d also simplify deductibles with a single annual deductible and increase protections to avoid catastrophic medical costs. First dollar coverage, now common with supplemental Medicare plans, would be eliminated to reduce their inflationary impact on medical utilization (i.e., when there’s no added cost for medical care, people often seek more than they need).

Taken together, these measures would spread the burden of reforms among all affected parties. They’d also impose a much more value-driven and coordinated modus operandi on our healthcare system than our current volume-driven system in which a third or more of our over-priced medical care isn’t needed in the first place.

And Beyond Medicare?

Private sector healthcare in America would also see significant changes through tax policy reforms. These are intended to replace the current “Cadillac tax” on gold-plated health insurance plans for highly-paid corporate executives with limits on corporate tax exclusions for employer-sponsored health insurance. The idea is to make current tax exclusions less regressive by capping them at 80% of employer-sponsored premiums and to remove the current preferential treatment given to self-insured corporate plans.

The net effect would be to encourage private insurance plans to also adopt alternatives to fee-for-service payments that now drive our medical overuse.

A second and crucial private sector initiative would be to clarify and enforce laws and regulations governing consolidation of providers and insurers. This trend is accelerating as Obamacare is further implemented and threatens to thwart any cost-savings it might otherwise produce. That’s because the bigger and stronger provider networks that emerge with consolidation of former competitors are better able to dictate prices in their respective medical markets.

This, of course, is anti-competitive. Yet much of healthcare is exempt from federal laws and regulations designed to prevent such anti-competitive practices. Hence the need for such reforms, especially given the accelerating pace of such consolidations across America as the industry girds itself for Obamacare.

Quality, Prevention & Wellness, Oh My!

The third leg of this three-legged post-Obamacare stool has its eye on our longer-term need for better treatment outcomes and prevention measures to reduce demand for medical care. It would do this not with fiscal gimmickry, but via the best means possible – by promoting greater health so less healthcare is needed.

Measures proposed would start by combining coverage for so-called “dual eligibles” (those eligible for both Medicare and Medicaid coverage). These tend to be those with highly complex medical needs that would benefit greatly – care-wise and cost-wise – with a more coordinated approach to their care. The current fragmented federal and state coverage is often inefficient and unnecessarily costly.

Another set of proposals in this category would offer federal financial incentives to states to adopt more coordinated and accountable models of healthcare delivery and payment. This would include strengthening the primary care workforce with more physician extenders – primarily nurse practitioners and physicians’ assistants.

It would also provide legal “safe harbors” to protect physicians who follow clinical best practices from unreasonable malpractice claims. This would reduce their reliance on defensive medicine practices that increase medical spending and often place patients in  harm’s way.

And, finally, greater transparency of medical prices and quality outcomes would allow patients and their families to make more informed medical decisions. Better informed consumers are essential to an efficient marketplace of any kind. Nowhere is this more needed than in our healthcare, where this prerequisite for market efficiency remains sorely lacking.

So What’s Not to Like?

Not very much is objectionable in this broadly-cast set of reforms – unless, of course, you have a vested interest in preserving the status quo. They’re intended to take us to a post-Obamacare healthcare system that better addresses our unsustainable medical spending.

Yet they’re unlikely to be enacted any time soon – at least by this observer’s reckoning – mostly because of who might get the credit for them. 

The political reality is that Republicans aren’t about to embrace anything that would lessen their ability to demonize Mr. Obama in next year’s mid-term Congressional elections. It’s what inflames their base and is their best shot, they believe, at increasing their legislative stranglehold on all things Obama.

And Obamacare still looms large in the bash Obama sweepstakes.

It’s really as simple – and as sad – as that.

Which means all these proposed measures – meritorious and overdue as they are – will have to await another day, if it ever arrives, when Obamacare is irreversible and the political calculus may again be more favorable.

All of which which leaves us to ponder whether our politics has outlived its usefulness when it so impedes our rational governance.

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4 Awesome Comments So Far

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  1. Donald Quixote
    August 23, 2013 at 4:19 pm #

    John:

    You have overstepped your bounds…

    1. Republican Jihadists – come one John…even if you don’t agree with them, you are trying to insinuate they are on a religious war that allows the violent murder of opposing parties in order to accomplish goals. Who is being extreme here?

    2. What right do they have to impose their minority?
    Are we kidding John? The setup of the U.S. government was created specifically to protect what otherwise would be unvoiced minorities…the practice of filibustering and other similar exercises have existed long before Obamacare. If you do not agree with what they are doing then change legislation so they cannot do it. Ironically minorites, especially when it comes to racial or socio/economic ones are heavily favored within the same arena!

    3. If you really do feel that some states are really being denied such marvelous benefits that Obamacare has to offer would it no be better to let the states individually decide than have a federally imposed law force it upon them?

    4. By the way…I have mentioned this in another comment but I disagree with Republicans on a number of issues and yes, I would agree that what they are doing is counterproductive when there are a number of other issues that need to be dealt with, and yes, I enjoy your website and your articles which is why I bother to read and comment.

    • John Lynch
      August 24, 2013 at 2:25 pm #

      At the risk of belaboring this, I do feel compelled to respond – and, by the way,I’m glad to engage on the topic as it’s so central to out current healthcare stalemate in America.

      1. I don’t agree that I’ve over-stepped my bounds, as you put it. Tea Party-ers are driving the Republican Party in the direction of America’s fringe militias – and even though they may not always be driven by religion, they share the same willingness to commit violence as jihadists. Like the Tea Party, they view the government as the enemy – and how far removed is the Tea Party’s frequent talk of secession from militia talk of preparing for government tyranny? Does secession not suggest violence? Our bloodiest war ever sprung from such an effort, you may recall.

      It’s all deeply pathological.I’d worry much more about this movement than your worry about Obamacare moving us in the direction of socialism. And it’s not extreme to recognize extremism – and call it what it is.

      2. The current threat of political brinkmanship – to shut down the government if a law passed through proper Congressional channels isn’t de-funded – isn’t about protecting minority rights and it’s disingenuous to try to lump the two together. Filibustering is now a routine Republican tactic to a degree far in excess of its original intent or historical practice. This is political hostage-taking and has absolutely nothing to do with protecting minority rights. Nothing, nada, zilch.

      3. Absolutely not. the problem is the states’ inconsistent application of the law. How could the solution possible be more of the same?

      And, by the way, there are lots of federally-imposed laws imposed on states. Why should this one be treated any differently than the rest? This objection to federal control, to me, smacks of Confederate nostalgia about the federal government interfering with states’ rights to permit slavery (damn Yankees!).

      4. This one surprised me after the first three. If you agree that current Republican tactics to obstruct Obamacare’s legal implementation are counter-productive, then what’s the beef?

      I’m glad you’re enjoying my posts, however – at least most of them. I try to balance my topics and not get totally immersed in the politics of Obamacare – partly because it’s an un-winnable rat-hole of an issue with no give on either side and partly because there are too many other healthcare issues that will persist with or without Obamacare.

      It’s to your credit that you’re able to disagree on the politics and still find merit in the rest. If more of us were able to do so, we’d generate a lot more light and a lot less heat.

      Thanks for your comments – all of them. We don’t have to agree on everything, but it’s nice to be able to agree on some of them.

  2. Donald Quixote
    August 21, 2013 at 7:17 pm #

    I have read a number of articles on your website and for the most part have enjoyed them, however, this article is very disappointing. It was pretty much a bash on republicans…which the author of the article accuses the republicans of doing to the president. While most of the content from this site is worth reading and very helpful this article was not.

    • John Lynch
      August 22, 2013 at 11:04 am #

      Thanks for commenting, Donald. I note you made 15 comments on various posts of mine and objected to their content on only two – both related to their criticism of Republican obstructionism of Obamacare. This tells me you must identify as a Republican, which is your prerogative. But were I you, if I found myself agreeing with all of 15 posts but two that challenge Republican orthodoxy, I might be questioning that Republican orthodoxy rather than defending it.

      I have no problem with traditional Republicanism, but that’s now rejected by the extremists who’ve hijacked the party in favor of never-say-die obstructionism. When your position is rejected in our legislative body and then in our highest court, it’s time to accept it and move on. Not so with today’s Republican jihadists, who now threaten to shut down the government if Obamacare isn’t de-funded. What right do they have to try to impose their minority will on the rest of America when it’s failed to win either legislative or legal support?

      This “My way or the highway” dictatorial mentality is fundamentally Un-American and has no place in our political discourse. And since Obamacare is its central target, there’s no way to cover healthcare in America without taking on the subject.

      You may not agree, but I see no alternative but to take on this obstructionist behavior that deprives millions of Americans of the benefits of Obamacare that those in states that embrace it are already realizing. And I make no apologies for it.

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