Wednesday, November 18, 2009

Health insurance reform only the first step?

To most people, the House-passed version of health reform, weighing in at 2,016 pages, might seem massive. (By contrast, the Senate bill, as it currently stands, is a svelte 1,502 pages.) It certainly seems quite large to me as I read and re-read it until my eyes glaze over. Even so, imagine how large the bill might have been if it had followed through on its initial promises.

Originally, the health reform effort referred to health care reform and part of the goal was to “bend the rising cost curve of health care downward” by enacting a reform of health delivery systems.

Over time, however, the rhetoric has shifted to that of “health insurance reform” meaning that the focus now is on reforming insurance practices. As National Public Radio has pointed out, “even as they're taking on the highly unpopular insurance companies, lawmakers are not requiring big changes in the way health care is delivered by doctors and hospitals. In turn, those providers are backing the health care plans moving through Congress.” The whole effort has become, in effect, health insurance reform without substantial cost containment measures or health delivery system reforms.

Because the measures currently being debated don’t provide a whole lot of health system delivery reform, at least one commentator, Paul B. Ginsburg, writing in the New England Journal of Medicine, believes that this bill, if passed, might be only the first step towards reforming the whole health care system. According to Ginsburg, if current health reform legislation were to be enacted, it “would be only a start to the reform process. Regulations will need to be written, organizations (such as exchanges) will need to be built, and midcourse corrections will need to be legislated to deal with unforeseen consequences. And since only tentative steps will have been taken to reform care delivery, policymakers will inevitably have to return to battle on that front.”

Massive as the current bill is, it could only be the first “tiny” step on the road to full health care/health system reform. Keep that in mind as Congress inches toward the finish line on health insurance reform.


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