The public plan is a non-negotiable for some in Congress, a nice to have for others, a bargaining chip for still others, and anathema to the rest. There aren’t two distinct blocs; rather there are a spectrum of views. This is critical to understanding the ‘role’ of the public plan in the process.
My sense is that – as far as the key players (Baucus, Obama) view it, the public plan is something of a trojan horse; try as I might I can’t see an overwhelmingly compelling reason to make the public plan option mandatory.
However, it is vitally important to Waxman and Kennedy and Stark, all key players in the debate, and to all of the Republicans except possibly the Senators from Maine.
This sets it up beautifully as a bargaining chip; the Obama/Baucus faction can use Waxman/Kennedy/Stark to get the GOP to make big concessions in return for a watered-down public plan option.
Myself, I don’t see the public plan as critical to reform, or perhaps more accurately it is not nearly as important as comparative effectiveness with teeth and reimbursement reform and taxing health benefits. That’s the important stuff.
While comparative effectiveness was part of the ‘stimulus’ bill, it was downplayed, perhaps to mute criticism from those who see it as a thinly-disguised rationing tool.
Help is on the way. The Patient-Centered Outcomes Research Act of 2009 was introduced earlier this week by Senate Finance Committee Chairman Max Baucus (D-Mont.) and Senate Budget Committee Chairman Kent Conrad (D-ND). according to the press release, it would create a private, nonprofit corporation, the Patient-Centered Outcomes Research Institute, to “generate scientific evidence and new information on how diseases, disorders and other health conditions can be treated to achieve the best clinical outcome for patients…Research would be conducted by trusted public and private organizations approved by the Institute’s diverse board of directors, which would include practicing doctors, patients, pharmaceutical and biotechnology makers.”
This has been tried several times before; grey hairs out there will remember the old Agency for Health Care Policy and Research (AHCPR) (now AHRQ) and the Patient Outcomes Research Team program. AHCPR was rendered all but powerless by defunding during the mid-nineteen nineties, driven in part by virulent attacks on the agency’s work by several physician groups.
AHCPR’s all-but-demise was partially its own fault, as early guidelines were viewed as weak and ineffective by some, and the development process itself drew fire from the Office of Technology Assessment. In fairness, this was the first real large-scale effort to develop and promulgate clinical guidelines, so it should have come as no surprise that the initial effort was not exactly perfect.
If the bill becomes law, Rockefeller’s Patient-Centered Outcomes Research Institute has a lot of history to learn from, a different political climate in which to develop, and a mandate to make a meaningful difference.
It is also our only chance to restrain cost growth in Medicare.
Jun
11
