A good start

Legislation reforming America's health-care system entered its next phase this week with debate beginning on the Senate floor. It is crucial to reform the health-care system in a manner that provides access to high quality affordable care.

The Senate has a unique opportunity to make major, positive changes to the health care system that affects every American. Here's my wish list:

· The quality measurement, payment reform and delivery system reform components of the bill are good first steps toward improving care coordination and modifying the fee for service payment system that rewards quality care over quantity of care delivered. More could be done in this arena. For example, the legislation should ensure that the Secretary has broad authority to quickly expand demonstration or pilot projects that are successful. In addition, the proposed Medicare Shared Savings Pilot could be expanded to include other reimbursement models such as partial capitation (similar to what is included in the House bill) and identify opportunities to better align hospital and physician incentives to work together to improve quality and efficiency.

· The current individual mandate is too weak to create a health care delivery system that is truly a shared responsibility. One option is to look to Medicare, where so-called "late enrollment penalties" are used to provide incentives for people to sign up for coverage as soon as they are eligible, rather than waiting until they get sick. These can be reasonably modest -- perhaps a surcharge of one percent per month for each month a person does not obtain coverage once they actually do sign up -- but they add up and they have worked to get virtually everyone in the system.

· The insurance premium revenue tax needs to be examined more closely as it favors fee for service payment while disproportionately affecting integrated delivery systems and certain geographies. This runs counter to the larger goals of the bill, to move away from fee-for-service payment and to better ways to pay providers, incenting high quality care rather than high volume care.

Patients, health care providers, employers and others are burdened with a health-care system that fails to deliver optimal care and this is an historic opportunity to change that. We need to get it right.

By Scott Young  |  December 4, 2009; 3:11 PM ET Save & Share:                 
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