Well...perhaps you can provide some factual information to support your claims of this debate...as well as data that shows that these changes you cite actually do result in lower health care costs.
It's known that the sorts of payment and delivery reforms that have been launched over the past few years have the potential to slow cost growth.
Pioneering initiatives launched by private payers have shown this:
Study: Mass. Global Payment Approach Lowers Costs, Improves Care
The Alternative Quality Contract, a global payment model put in place by Blue Cross Blue Shield of Massachusetts in 2009, has both curbed costs and improved the quality of care, according to a Harvard Medical School study published today in the journal Health Affairs.
Global payments, a lump sum to cover all the care of a defined group of patients, are viewed by many experts as a cost-effective alternative to the traditional fee-for-service system.
Massachusetts enacted sweeping state health reforms in 2006 considered by many to be a prototype of the 2010 federal health law, and it is now experimenting with equally dramatic measures to rein in health care spending. The AQC is very similar to the Affordable Care Act’s Pioneer Accountable Care Organization contracts – a part of the Medicare shared-savings program.
ACO Saved CalPERS a Total of $37M Over Two Years, Report Finds - California Healthline
An accountable care organization that serves thousands of CalPERS beneficiaries in the Sacramento area saved the agency a total of $37 million in 2010 and 2011, according to a report published Thursday in the journal Health Affairs, the Los Angeles Times reports.
Background
Under the federal health reform law, Medicare officials are awarding contracts to insurers, hospitals and physicians who form ACOs. ACOs seek to coordinate patient care and improve care quality and efficiency. In 2010, Blue Shield of California, Dignity Health and Hill Physicians Medical Group formed an ACO to serve 41,000 CalPERS beneficiaries in the Sacramento area.
And those launched specifically by the ACA have been promising so far:
Obamacare Shows Hospital Savings as Patients Make Gains - Bloomberg
Less than five months before the Affordable Care Act fully kicks in, hospitals are improving care and saving millions of dollars with one of the least touted but potentially most effective provisions of the law. . .
Under the program, hospitals and physician practices take responsibility for tracking and maintaining the health of elderly and disabled patients. If costs rise beyond an agreed upon level, hospitals may become responsible for reimbursing the government. If they cut the cost of care while maintaining quality, hospitals share in the savings. The government expects the savings may be as much as $1.9 billion from 2012 to 2015. Early indications suggest they are starting to add up. . .
Under the U.S. health reform law, Medicare’s accountable-care program requires hospitals and doctors to show they are improving or maintaining the quality of their care before they are paid any bonuses, Blum said. More powerful technology will also help. And unlike in the ’90s, today’s programs are backed by a new law, providing “some surety that the agency will have a commitment to the program,” Blum said.
And in a different, more targeted (but related) experiment launched under the ACA,
more than half the participating organizations were able to save money:
Overall, CMS reported that for the more than 669,000 Medicare beneficiaries who belong to Pioneer ACOs, costs to treat them grew by 0.3 percent in 2012. That compares with costs for similar beneficiaries outside the ACO model, which grew by 0.8 percent. CMS said the Pioneers that produced shared savings netted $33 million for the Medicare Trust Funds and that those ACOs together shared in more than $76 million as a result of their coordination of care.
Given the rapid expansion of these care models under the reforms of the past few years, somewhere around
14% of the population is now directly served by one, with the potential for
additional spillover effects beyond that. State level versions of this approach (some supported by federal dollars under the ACA) are also getting into the act, with promising early results starting to trickle out of states like
Colorado and
Oregon just in the past month. We also seen the
first first readmissions reductions in years as ACA payment reforms and care coordination programs kicked in.
Back in 2011, reforms to use
bundled payments also started to gain traction, based on previous demonstration that successfully used them to slow cost growth:
The Bundled Payments initiative is being launched by the new Center for Medicare and Medicaid Innovation (Innovation Center), which was created by the Affordable Care Act to carry out the critical task of finding new and better ways to provide and pay for health care to a growing population of Medicare and Medicaid beneficiaries. . .
The Bundled Payments initiative is based on research and previous demonstration projects that suggest this approach has tremendous potential. For example, a Medicare heart bypass surgery bundled payment demonstration saved the program $42.3 million, or roughly 10 percent of expected costs, and saved patients $7.9 million in coinsurance while improving care and lowering hospital mortality.
These are real effects that save real money.
But if you want a succinct summation of this argument, just read the new Surowiecki piece:
James Surowiecki: Is Health Care Spending Finally Falling? : The New Yorker
