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Will health reform help control costs?

Marketplace Staff Mar 22, 2010

Will health reform help control costs?

Marketplace Staff Mar 22, 2010


Kai Ryssdal: As much fun as the last year or so of debate and discussion have been, it’s not completely out of line to say things are only going to get trickier from here. Because before, a lot of the talk was hypothetical, about what would happen and what might happen. Now, those changes are going to happen. Both in insurance coverage rules and, one hopes, health care costs. Here to help us understand what we might expect is Elizabeth McGlynn. She’s a health policy analyst at the RAND Corporation. Elizabeth, good to have you with us.

Elizabeth McGlynn: It’s great to be with you.

Ryssdal: This debate so far and the bill itself seems to be really about insurance reform. Talking about coverage and who can do what to whom in the insurance world. Anything in there that leads you to believe we’re going to get more cost-effective care?

McGlynn: Well, I think that there are several provisions in the legislation that will help us get more cost-effective care. And the most promising one is a new center for innovation which is placed within the centers for Medicare and Medicaid services. That’s the group that administers the Medicare and Medicaid program. It gives funding to the center to explore lots of ideas that people have had about ways that we might pay for care differently, deliver health care differently, and it gives an opportunity for them to more rapidly study how well those ideas work when we go try them on a larger scale. And then be able to implement them more broadly without having to necessarily go back to Congress and say, we have a great idea, what do you guys think, let’s pass this. So this really gives us a chance to test everybody’s great ideas, and see if we can move the system in a different direction than we’re moving right now.

Ryssdal: A series of pilot programs then, right?

McGlynn: A series of, yeah.

Ryssdal: Let’s see if this works, and we’ll check it out.

McGlynn: Yeah. Exactly.

Ryssdal: I’m sure you saw that graph during the whole debate that had life expectancy on one side and then cost per capita of health care on the other. And you had Japan and the Western democracies right about 75-80 years and $2,000-$3,000 per capita. And then you had the United States way out on the other side of that graph at $7,000 per capita or maybe even more. When are we going to start moving closer in to the rest of the world?

McGlynn: Well, I think it is not clear that we ever will move closer to the rest of the world. I think there are a lot of things about the way the U.S. health care system is organized and operates today that may make it tough for us to ever look like the rest of the world. I think a question is could we get better at moving health care spending to be more in line with our economic output, so that we’re not taking an increasing share of the Gross Domestic Product to be spent on health care. And you know, I think that’s going to take us a few years. It’s a big, complicated system that is with a lot of entrenched interests, and it will take us a while to make a really significant shift in those curves.

Ryssdal: Is there going to be more transparency, though, for the average person to know how this health care system functions, and how the cost-benefit ratio works?

McGlynn: Well, I think there’s a lot of emphasis on trying to improve transparency in the health care system. And by that we mean both how good is the quality of care that people are getting, and how much is the cost of that care. There has already been a lot of effort to make the health care system more transparent, and I think that that will only increase. The stimulus package had a big investment in health information technology and accelerating the adoption of those technologies, and also has money to try to improve the flow of information so that we can provide data to people, information to people as they’re making choices, not only about what health plan to enroll in, but what doctor to see, what hospital they may want to go to for certain procedures. So I think all of that will make it easier for people to have a better sense of what it means for them.

Ryssdal: Elizabeth McGlynn at RAND. Elizabeth, thanks a lot.

McGlynn: Thank you.

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