Finally, there is some good news on the health care
The headlines went to a possible compromise on the contentious issue
of the public option, but the greater victory may lie in less-publicized
Senate action that might actually cut the costs of our impossibly expensive
health care system.
This week, the outlines of such a change emerged in a package of
amendments proposed by 11 freshman Democratic senators who have an
abundance of common sense that more than compensates for their lack of
seniority and renown.
Since they came back from their August recess, with the angry words of
their constituent town meetings ringing in their ears, the nine men and two
women who were newly seated in the Senate majority have been meeting weekly
to see what they might contribute to moving the process forward.
As Virginia's Mark Warner, one of the leaders of the informal group,
told me, "We knew we were seated at the kids' table," not being members of
the elite Finance Committee. But many of them were accustomed, from their
jobs in state and local government, to working out similarly snagged policy
So they reached out to some of the major players outside Congress and,
as several of those interest group experts told me, did the hard work of
exploring for themselves how the emerging legislation might be improved.
The product of their exercise is a package of amendments that they
argue will "broaden and accelerate efforts to encourage innovation and
lower costs for consumers across the U.S. health care system."
Many of the proposed changes come with the endorsement of business,
labor, consumer and provider organizations. While the drafters were all
backbench Democrats, they were operating with the blessing of Majority
Leader Harry Reid and their package was immediately endorsed by Sen. Susan
Collins of Maine, a moderate Republican.
By keeping their goals modest and focusing on changes that can have
practical benefits, the freshmen greatly improved the chances that their
proposals will survive in any legislation that reaches the president's
Their work was praised by many who helped develop it for recognizing
that parallel changes must come in Medicare and Medicaid, as well as in the
private sector of medicine. They also grasped that we need to make more
robust use of field experiments in how to do that.
This builds on a growing awareness of the fact that buried in the
thousands of pages of the legislation passed by the House and pending in
the Senate are authorizations for pilot programs testing a wide variety of
changes to coordinate care and reduce costs.
They have been there all along, but until recently were obscured by
the fight over the public option, abortion and other headline-grabbing
issues. These pilots would test such approaches as offering a comprehensive
fee, rather than billing for each doctor or test when, for example, a heart
attack or diabetes patient is first treated, or rewarding or penalizing a
hospital depending on its rate of hospital-incurred infections.
Coincidentally, just as the freshmen were preparing to introduce their
package, expanding significantly the scope of the pilot programs, The New
Yorker magazine published a piece in its Dec. 14 edition by Atul Gawande
highlighting the potential of such experimentation. Gawande, a Boston-based
physician-journalist whose work is often cited by President Obama, has
become perhaps the most influential outside voice in the health care
debate, especially on the issue of curbing ruinous medical inflation.
Gawande argues that the historical example for spreading cost-cutting
innovation through government-sponsored pilot projects can be found in the
Department of Agriculture extension system. In the first decade of the 20th
century, county agents persuaded a handful of farmers to use modern
scientific methods of cultivating land and raising crops, and their success
quickly spread to thousands of others. We are still reaping the benefits of
a transformation that was facilitated not ordered by government.
We badly need a similar transformation in health care, and the
freshmen's amendments may help bring it sooner.