US: Improvements sought for health insurance law

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While the future of the 2010 health care law stabilised with the re-election of President Obama, both Democrats and Republicans say now is the time for them to come together to fix it, reported on Saturday.

“They need to actually create some solutions together,” said Don Berwick, former administrator of the Centres for Medicare and Medicaid Services. “I’ve had a few conversations with people from both sides; everyone resonates with the idea that something needs to happen.”

Until Tuesday, when Obama’s future was determined, Republicans opposed to the law waited for a change in administrations that would allow them to repeal the law. That will not happen now with a Democrat in the White House for the next four years. Repeal is no longer an option, and House Speaker John Boehner, R-Ohio, called it the law of the land.

But changes are imminent. “It’s pretty clear to me that the [law] will not end up the way it is now,” said Doug Holtz-Eakin, president of the American Action Forum and former economic policy adviser to 2008 Republican presidential nominee John McCain.

The analysts do agree on one thing, even if they don’t necessarily agree on how to go about it: Cutting costs through provider payments, rather than through the health care system itself, won’t cause health care costs to stabilise.

“I think with the lack of continuity in care and excess costs to the system, the very best way to address the problem is to improve care,” Berwick said.

That’s partially built into the law with a move toward coordinated care in Medicare, as well as charging hospitals if a Medicare patient is readmitted for preventable issues. But more must come from prevention, experts say.

“We’re not going to cut entitlements by continuing to cut payment rates,” said Ken Thorpe, chair of the department of health policy and management at Emory University in Atlanta .

Instead, he said, lower costs must come from encouraging people to take better care of themselves through proven diabetes-management and weight-loss programs, as well as improved coordination of care inside medical organizations so everyone on a team knows what the other is doing for a patient.

“We need to avert disease in the first place,” Thorpe said. “All of our growth is in multiple chronic health problems. The IPAB and premium control won’t work without prevention.”

The IPAB is the Independent Payment Advisory Board. The president-appointed and congressionally approved board goes into effect when Medicare and Medicaid spending goes above a certain level. It can determine if payments to providers should be lowered, but it may not do anything to affect the care received from those programs, such as by limiting the kind of care a person receives. Congress may reverse the board’s actions by passing legislation for specific recommendations.

Holtz-Eakin said the board “will go away. Only being able to cut payment to providers is always going to backfire.”

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