Is Cutting Health Care Costs Off the Table?

Between the town hall chaos and the claims of some prominent Republicans of a vast left-wing conspiracy to euthanize your grandmother, the details of what’s actually in the proposed health reform bill have pretty much gotten lost. But a conversation I had yesterday with Karen Davenport, health care policy director at the Center for American Progress, suggests that some of the primary ways that experts have suggested cutting health care costs — by changing the current system’s incentives for doctors to recommend unnecessary tests and procedures — is not likely to be a big part of the new health overhaul.

Davenport said the House bill does include some pilot programs that would test changing these incentives, which could be expanded if they turn out to be successful. But the basic reimbursement system, in which doctors get paid for every appointment or procedure they perform, rather than a set fee for providing care, would not necessarily change.

President Obama has said that the current system “rewards the quantity of care rather than the quality of care,” and most experts agree that this leads to unnecessary and potentially harmful medical practice, while encouraging the spiraling of health care costs. So why isn’t this a bigger emphasis in the bill?

The House bill, said Davenport, does make some changes, such as “increasing payment for primary care providers in Medicaid,” and “creating bonus payments for primary care providers in Medicare in certain underserved areas.” In other words, give doctors incentives to be primary care physicians rather than specialists, and to go where medical help is needed. But that still doesn’t address the incentives for specialists.

Already, the law requires doctors to disclose any financial interests they have in other health care facilities they’re referring patients to. But what about a surgeon who recommends surgery when it’s not necessary or even likely to help?

Congress, of course, is understandably reluctant to wade into that sensitive territory, because the anti-health care reform movement will immediately attack anyone who suggests such measures for stepping between doctors and patients, or “rationing” medical care in some supposedly socialist fashion. HMOs already do this sort of “rationing,” and often not well, given that their incentive is simply to cut costs and increase profits. But a provision in the health reform bill that addresses the problem of doctor’s incentives at a deeper level across the health system would likely go a long way toward bringing down the cost of good medical care.

Now let’s see if anyone in Congress is willing to stand up to the clamoring obstructionists and actually offer a serious cost-cutting proposal.