There has been substantial debate in recent days about whether the pending House and Senate bills have the kind of robust cost containment we need to really "bend" any health care cost "curves."
Readers of this blog know of my concern that these bills amount more to expensive entitlement expansions than what we will really need to attack the underlying problem of costs.
Yesterday, Orszag conceded what is on the table is "not sufficient" to address longer-term cost problems:
"Fiscally responsible health reform is necessary but not sufficient to address our immediate-term deficit and long-term deficit problem, and there is more that will be necessary. We'll be talking more about that next year."He also conceded that the Medicare commission proposed in the Senate bill--which can't touch hospital costs and likely physician costs--falls short:
“The key thing at this point is the Medicare commission exists," Orszag said. “There are things as we move forward that will need to be tweaked or modified, and there is significant discussion ongoing about whether the Medicare commission could be modified."Orszag's comments are appreciated because, I will suggest, that if we do get something close to the existing bills it will be critically important that everyone understand what they do and what they do not do to contain costs. Recent comments on the subject of cost containment by the administration, Democratic Congressional leaders, and their supporters have pushed back hard against people who are concerned far too little is being done to control costs--comments like, "I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."
Clearly it would be better to just do it right from day-one--particularly because now is when we have the momentum to get the most done. But failing that, let's not mislead the people on just how much would be left to do.
Orszag showed a lot of integrity in saying what he did and his comments should serve as an example for everyone on all sides of this debate that too often put more emphasis on spin than substance.
I would also call you attention to an excellent column on cost containment and the Democratic bills by James Capretta, "Debating Cost Control," at Kaiser Health News.