Fifteen wonks walk into a room to fix Obamacare. That’s not a set-up to a joke, but an experiment Politico ran as the first installment of its new venture “The Agenda,” a series about important policy questions driving legislation and public debate. It convened former bureaucrats, current politicians, and health care experts to assess how the law is doing and what policymakers should do next.As Politico points out, the 15 participants agreed “that health-care costs in the United States are too high.” They disagree widely, however, about the degree to which the ACA has helped with that problem, and strategies for addressing it going forward. Liberals generally support malpractice reform, and conservatives call for loosening the restrictions on catastrophic plans. Some wanted to tweak or replace the norm that employers provide insurance, which seems like a necessary and important step.But none were as straightforward as we would like about the real need here: a functioning marketplace that encourages reforms in how health care is delivered. Two came closest. Here’s former HHS Secretary Donna E. Shalala:
We have been moving in the right direction by placing greater emphasis on shorter hospital stays, outpatient services, home health care and skilled nursing facilities as an alternative to hospitals and nursing homes. But there are tremendous savings still to be realized through further adaptations to our health-care system to tackle the challenges of an aging and sicker population, a shortage of primary care providers, lack of preventive care and continued, skyrocketing costs. These include greater coordination of care between physicians, nurses, specialists, hospitals and other centers patients turn to for health care. We must expand access by ensuring that highly skilled nurses are full partners with doctors and can practice to the highest level of their training
And here’s former Senate Majority Leader Tom Daschle:
The health-care marketplace needs to be far more transparent on both cost and quality. No sector of the economy can operate efficiently without an ability to compare data….Today we are experiencing the Wild West in technological advancement, with vast new data troves, as well as new products and services that hold great promise for health care. But greater patient engagement with these technologies, encouraged by more user-friendly infrastructure and better interoperability among different databases, is essential. It falls to the government to synchronize our policy and regulatory framework with advances in technology. Telehealth, for instance, holds great promise for health care delivery, including the return of the house call. But regulatory and licensing obstacles continue to obstruct meaningful progress.
Both of these entries get some of the elements right: empowering nurse practitioners, increasing price transparency, and moving towards innovations like telehealth (and, we would add, clinics). That one served under a Democrat, and one was a key Democratic leader while on the Hill, shows that these kinds of reforms have bipartisan support; price transparency has long been important to the health care policy right, for example.If the next health care reform debate can focus on the big picture of market innovation and service delivery reform instead of minute tinkering with federal subsidy levels, that would be progress indeed. That only two out of the 15 entries broached these issues, however, doesn’t give us much cause for optimism.