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Aiming health reform at doctors’ pay

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Kai Ryssdal: For all the months of debate and endless negotiation, the real work of figuring out what a health-care bill might eventually look like will start not long after 10 o’clock tomorrow morning. That’s when the Senate Finance Committee is scheduled to vote on its reform plan. The three House proposals and two Senate versions will eventually be married up into one plan for the president to sign. It will, probably, expand insurance coverage and do some other things. But it might not actually do much to control health-care costs. You want to do that, you have to change the way medicine is practiced. Joel Rose explains.

JOEL ROSE: For all the talk in Washington about reshaping our health-care system from the ground up, some say the Senate Finance Committee’s aims are relatively modest.

DANA Goldman: This is a rather historic effort to provide insurance to most Americans. But this is not an effort to do anything on cost containment.

Dana Goldman teaches health policy at the University of Southern California [where he is director of the Schaeffer Center for Health Economics and Policy]. If you really want to control spending, Goldman says, you have to stop paying doctors for the quantity of services they provide and reward them for using treatments that save money and lives.

Goldman: If the patient does well, then the hospital gets paid, the doctor gets paid. And if the patient doesn’t do well, then they’re going to have to bear the cost. And ultimately, that would’ve been a really valuable change.

There are some pilot and demonstration projects in the Senate Finance bill that are supposed to lead to that kind of change. Goldman says they’re little more than a “fig leaf.” But for others, they’re better than nothing.

ELLIOT Fisher: If you’re going to change the delivery system to improve care and lower costs, you can’t do it all at once.

Elliot Fisher teaches health policy at Dartmouth College. He says skeptical doctors and hospitals need to see that these innovative payment structures can be made to work on a small scale.

Fisher: This bill provides the foundation that will let us all start to work together to make those changes that will slow the growth of health-care spending.

In the meantime, experts say that none of the bills in Congress would do that.

I’m Joel Rose, for Marketplace.

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