What's Right and Wrong with RomneyCare: Mark McClellan's View - Mark McClellan on the Affordable Care Act: 'It's an important step.'
Ezra Klein:
Ezra Klein - Mark McClellan on the Affordable Care Act: 'It's an important step.':
MM: It's an important step. We have to do something about the problem of access to affordable health insurance. The bill unquestionably does that. The provisions related to changing provider payments are significant in terms of their potential for reducing spending growth, though I'd have liked to see more of those steps.... The provider payment reforms. The president likes to say that all the good ideas experts have are in the bill, and that's largely true when it comes to payment reforms. But since we don't know exactly which of those reforms work, we'll have to find out quickly. And that will require doing a fundamentally better job of running the pilot and demonstration programs in Medicare.... More important, I think, are the reforms that pay doctors and hospitals more when they get better outcomes for people at a lower overall cost.... The most important reforms on the payment side don't tell doctors and hospitals what they need to do or but support them when they figure out how to do things better.
I was part of a bipartisan group of economists and other health-care experts that did a report on bending the curve. On that list, but not included in full in the bill, was reform of the medical liability system. We also included a big emphasis on consumer side reforms. If people could take steps to stay healthier and reduce their complications, we could provide support for them as well.... If people use providers who have demonstrated that they can get better outcomes with fewer complications, we should support them in that.... When I was at CMS, providers came to me and said we can show we're delivering better care at lower results, but we don't get paid for this... we lose money because we're doing less of the traditional billing: We've got fewer lab tests and doctor visits....
I... want to make sure people can choose innovative kinds of plans and innovative kinds of care... five years from now we'll hopefully see insurance plans that look very different, that don't automatically make you pay $15,000 when you have a serious illness but reward you for making good decisions.... And... we'll probably have to take some further steps in controlling costs.
