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Scoring Points and Buying Time

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I’m just back in my hotel room after a long day on the Hill, with more thoughts and impressions than I have the energy to cover. So I’ll focus on two: the Congressional Budget Office (CBO) scoring of the House and Senate reform bills and the issue of “to delay or not delay” voting on these bills.

On the CBO…you can go to http://cboblog.cbo.gov/?p=332 to see Director Douglas Elmendorf’s blog for some of their analysis. But it was his testimony this week to Congress that ignited partisan flames that I hope get smothered pretty darned quickly. The press has jumped on these big numbers ($1T, or $1.6T) like moths to a flame (don’t ask me where all these fire images are coming from) which simply inflames (ugh!) the fears of the public with overly simplistic soundbytes. Many Republicans are on the attack now using the CBO scoring to try to kill the whole healthcare reform effort. At the same time, many Democrats are rushing the legislation and glossing over the legitimate fiscal concerns that the CBO report brought to light. Each side is trying to score partisan points with their comments instead of putting their energy on the challenge of increasing access while reducing costs simultaneously. So, several thoughts on this…

First, I think the CBO itself needs some reform, if we are to achieve real healthcare reform. I’m not an economist or finance person by any stretch of the imagination, but it’s commonly lamented in D.C. that the CBO only calculates the projected costs of legislation, not the potential savings. How can we not be factoring in the long term savings and ROI on potential investments? It’s going to be really difficult to get telehealth and personal health solutions to take hold in the U.S. if only the costs of implementing them are calculated, without taking into account the reductions in hospital admissions, the efficiency gains, the diseases that were prevented or detected much earlier, and the quality of live improvements.

Second, if healthcare reform doesn’t cost more money, at least during some transition phase for several years while we move from the old model to the reformed model, then we’re probably not really doing healthcare reform. In that case, we’re probably just moving buckets of money around on a gigantic, titanic healthcare system. It’s got to cost more money to cover the uninsured, invest in health IT, grow the pool of primary care physicians, transition to a care coordination model, and so on. We should see returns on those investments that save money elsewhere by implementing a new delivery and payment system, but the startup costs for reform are going to be big numbers.

Third, I completely agree with CBO Director Elmendorf’s comments that the House and Senate health reform bills don’t propose the sort of fundamental changes necessary to reduce costs of care. This is exactly why we can’t focus only on coverage/access…we have to fundamentally reform the delivery and payments systems towards the kind of Personal Health model I’ve been pushing. If we don’t stop using hospitals/clinics as the one-size-fits-all tool for every healthcare need, then costs are going to skyrocket. If we don’t incentivize clinicians and enable consumers to do coordinated care, self care, prevention, and earlier detection, then we’re going to be in trouble.

Finally, the good news about this CBO debate is that it seems to be sparking discussion of delaying the healthcare reform bills until more of the complexities can be worked through. Of course, we are once again offered false partisan dichotomies between “rush reform or it will never happen” versus “stop everything in reform because this is a train wreck.” Buying Congress and the Administration more time to figure these incredibly complex issues out—and to explain to the American people what all this means for us—is a good thing. Let’s not rush it…let’s not derail it…let’s do it right…and in phases and timeframes that make sense.

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