MY VIEW: Alice Rivlin

In an article from The New England Journal of Medicine, CRFB board member Alice Rivlin along with former Senators Tom Daschle, Pete Domenici, and William Frist, leaders of the Bipartisan Policy Center's Health Care Cost Containment Initiative, present a brief summary of their plan to strengthen the U.S. health care system. The full report released this April contained roughly $560 billion in options to reform federal health programs and bend the health care cost curve.  Much of their proposal overlaps with other recent health care cost containment plans, including health care recommendations in A Bipartisan Path Forward.  

In this summary of their report, the authors demonstrate the need for significant health care reform and briefly present a few of their recommendations to accomplish this.

Despite high national spending, health care in the United States is uneven in quality and often wasteful, uncoordinated, and inefficient. Leaders on both sides of the political aisle, and in the health and economic policy communities, recognize the urgency of improving the quality and effectiveness of care while slowing the growth of spending. Far too often, however, attempts to address our national health and budget issues have been fragmented and unproductive, frequently owing to partisan disagreements over how to approach these highly sensitive issues.

In the long term, we envision health care that is value-driven and coordinated through organized systems, rather than volume-driven and fragmented. These systems will be developed and will evolve through a process of innovation and improvement that is based on collaborative structures of care delivery and payment with accountability, coordination, competition, and patient choice. The tools and incentives built into these systems will ensure that patients receive high-quality, coordinated care across multiple settings. They will avoid unnecessary or redundant treatments and services, engage patients in decisions about their care, and pay physicians for the services that patients need and want — including increased time consulting with their doctors. Our recommendations seek to align efforts in the public and private sectors to promote high-quality, coordinated systems of care. Our Medicare reforms include steps toward greater coordination in care delivery and payment, such as shared savings, bundled payments, and competitively bid, capitated health plans.

Reforming the U.S. health care system is a challenge that must be tackled in order to manage our long-term fiscal outlook due to the slated increases in medical care expenses and the retirement of the baby boom generation.

We are convinced that reforming the U.S. health care system to prioritize quality and value over volume will not only improve health outcomes and the patient experience but also constrain cost and produce system wide savings. If enacted, our policies would reduce the federal deficit by an estimated $560 billion over the next 10 years, including nearly $300 billion in Medicare savings, which includes the cost of a permanent fix to the sustainable growth rate (SGR) formula for physician payments and the cost of increased assistance to low-income beneficiaries.

Our initiative is unique in that we have brought bipartisanship to the table, dedicating nearly a year to reasoned negotiations to break through the partisan rhetoric surrounding health care. We sought policy options around which both sides of the political aisle could realistically coalesce, and we prioritized political and economic realities over discrete options that achieve budget savings in the near term. We have been encouraged by the responses to these recommendations from representatives of both political parties.

There remains hope that this plan and other similar proposals will be able to bridge many of the gaps between Democrats and Republicans in order to achieve bipartisan entitlement reform. This type of reform and cooperation will be necessary to not only create a more fiscally responsible and sustainable budget outlook, but also to provide more efficient and quality care from our health care system to those who depend on it most.

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"My Views" are works published by members of the Committee for a Responsible Federal Budget, but they do not necessarily reflect the views of all members of the committee.