Health care reform is not on autopilot

With the Senate passage of its health care reform bill early Monday, it appears likely a version of this legislation will win congressional approval early next year.

There will still be some tinkering, as the House and Senate try to reconcile different aspects of their bills, but final votes on the reconciled bill will require only a simple majority, not the 60 votes the Senate needed Monday.

The Daily Sentinel made clear our concerns about the Senate bill a little more than a week ago. Now that the bill appears on its way to passage, it’s time to examine measures in the bill we believe are beneficial and could transform our health system for the better.

There is the bill’s aim to expand health care coverage to an estimated 30 million Americans who currently have no insurance. Whatever one thinks of the bill’s price tag and policy changes, that will certainly be an improvement from the current situation.

The fact the Senate backed away from adopting a government-run, public option for insurance coverage is also to its credit. We hope the bill will stay true to President Obama’s promise of not raising taxes on Americans who make less than $250,000 a year.

But perhaps the most promising aspect of the bill can be summed up in two words: pilot programs.

Physician Atul Gawande, writing in a recent issue of The New Yorker magazine, explains the benefits of the pilot programs.

Gawande is the same author who put Grand Junction’s health care system on the national radar with a New Yorker piece last spring that examined successful and unsuccessful regional health care systems. He placed Grand Junction’s system in the successful category. The Senate legislation encourages some of the best components of the Grand Junction system, such as improved electronic record keeping, to be used nationwide.

In his latest article, Gawande makes a persuasive argument that the abundance of pilot programs in the health care bill is akin to the method used by the United States to revolutionize agriculture at the beginning of the 20th century.

At that time, he noted, food costs gobbled up 40 percent of an average family’s income and farmers were reluctant to adopt new practices and technology. Rather than issuing edicts requiring farmers to reform, the government created a number of pilot programs that allowed a few farmers to test new practices and technology. Those that worked quickly became popular with other farmers and became widely used.

The pilot programs changed over time as new scientific advancements occurred. But they continue today through the U.S. Department of Agriculture and state extension services.

The Senate bill is chock full of pilot programs. We applauded several of them in our Dec. 13 editorial — programs that seek to encourage quality of care and cost containment over policies that encourage health care providers to see high numbers of patients or conduct large quantities of medical procedures.

Gawande noted that almost half of the 2,000-plus pages of the Senate bill are devoted to pilot programs, for everything from bundling of medical services to reducing infections in hospitals

“In the end, (the bill) contains a test of almost every approach that leading health care experts have suggested,” he wrote.

Therein lies the potential salvation, both for this legislation and our health care system. It is a massive bill, to be sure, with a multitude of interconnecting parts. But it is not a government masterplan — not a single route mapped across an extremely complicated health care landscape. Instead, it offers many potential routes to improve health care and contain costs, most of which will be tested through pilot programs and revamped or discarded as their success is evaluated.

Food now accounts for only about 8 percent of the average family’s spending, because U.S. agriculture has become the most productive and cost-efficient system in the world. It did so through technological advancements and government pilot programs that encourage innovation, not through a government takeover of private agriculture.

We can only hope that, through the programs about to be set in motion with this legislation, scholars will one day be able to say the same about our health care.


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