While the future of the 2010 health care law stabilized with the re-election of President Obama, both Democrats and Republicans say now is the time for them to come together to fix it.
"They need to actually create some solutions together," said Don Berwick, former administrator of the Centers for Medicare and Medicaid Services. "I've had a few conversations with people from both sides; everyone resonates with the idea that something needs to happen."
Until Tuesday, Republicans opposed to the law waited for a change in administrations that would allow them to repeal it. With a Democrat in the White House for the next four years, repeal is no longer an option, and House Speaker John Boehner, R-Ohio, called it the law of the land.
But, "It's pretty clear to me that the (law) will not end up the way it is now," said Doug Holtz-Eakin, president of the American Action Forum and former economic policy adviser to 2008 Republican presidential nominee John McCain.
The analysts do agree on one thing: Cutting costs through provider payments, rather than through the health care system itself, won't stabilize health care costs. "I think with the lack of continuity in care and excess costs to the system, the very best way to address the problem is to improve care," Berwick said.
That's partially built into the law with a move toward coordinated care in Medicare, as well as charging hospitals if a Medicare patient is readmitted for preventable issues. But more must come from prevention, experts say. "We're not going to cut entitlements by continuing to cut payment rates," said Ken Thorpe, chairman of the department of Health Policy and Management at Emory University in Atlanta.
Instead, he said, lower costs must come from encouraging people to take better care of themselves and improved coordination of care so everyone knows what the other is doing for a patient. "We need to avert disease in the first place," Thorpe said. "All of our growth is in multiple chronic health problems. The IPAB and premium control won't work without prevention."
The IPAB is the Independent Payment Advisory Board. The board goes into effect when Medicare and Medicaid spending rises above a certain level. It can determine if payments to providers should be lowered, but it isn't allowed to affect the care received from those programs. Congress may reverse the board's actions by passing legislation for specific recommendations.
Holtz-Eakin said the board "will go away. Only being able to cut payment to providers is always going to backfire."
State exchanges -- the websites created by states to let people quickly and easily compare and choose insurance plans -- are a "very sensible idea," Holtz-Eakin said. But the states should create them, not the federal government, he said.
So far, however, some states led by elected officials opposed to the law have delayed creating exchanges, which will mean the federal government will create exchanges for them.
Some people may have too many health benefits under the law and will consume more care, said John Goodman, president of the National Center for Policy Analysis and a promoter of private-sector solutions to health care issues. That could drive up overall costs unless people have high-deductible plans that force them to shop for better prices.
Otherwise, "Costs will continue to grow," he said. "Obama didn't create this problem; it's been going on for 40 years. I think you have to deal with the problems."
That's where the differences lie: Thorpe argued that a $5,000 deductible won't help someone who is already dealing with chronic illnesses. "The market doesn't matter much when someone is already sick," he said. "The challenge is more on the clinical management side."
Julie Barnes, director of health policy at the Bipartisan Policy Center, said the country needs a bipartisan plan for the whole health care system -- not just Medicare and Medicaid. "We need comfort that our doctors can focus on taking care of us, insurers and employers can help keep costs down, and we all start taking more responsibility for our own good health," she said.
"A bipartisan plan would include paying health care professionals for keeping patients healthy, modernizing facilities with the technology that would streamline processes and reduce medical errors, and cut back on unnecessary tests and treatment by better coordinating care for patients." And that, she said, would go a long way toward fixing the economy, because health care takes up much of the budget.
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