(Picture for Wikipedia by David Shankbone.)
Opponents of reform use this supposed contradiction to argue that no such control is possible, or that the result will mean denial of necessary care.
There are ways to do it. Problem is, the new law expects states to take action, and states were captured by the industries they regulated long before the national government was.
There are five courses of action states need to take for the law to succeed, but they all come down to one simple requirement -- encourage the development of new business models:
- Cut administrative costs by requiring that insurers and hospitals harmonize payment systems.
- Make sure providers make investments under HITECH that will give the state data on who's cutting costs, then publicize it.
- Demand payment reform through insurance commissioners. Bundling all payments for a condition, and paying for performance rather than procedures, are both within regulators' power.
- Encourage the creation of new kinds of health organizations, which accept bundled and per-patient fees.
- Support wellness programs, like better school lunches, exercise, and efforts against chronic conditions like diabetes and heart disease.
Reformers like David Kibbe and Brian Klepper are despairing over the industry's refusal to change business models in the face of health reform, and its insistence on treating reform as a cost to be passed on, rather than as an opportunity for change.
So long as hospitals and insurers see change as a threat to their profitability, they write, "the odds of the new law remaining intact, with teeth, are questionable."
The problem is that the failure of reform will price even more of the middle class out of the health care market. The market's growth is unsustainable, period, but its players refuse to accept that reality. Which is crazier than Christine and Rosie O'Donnell put together.