Thursday, May 7, 2009

An Open Letter to the Men and Women Over at the CBO--Hang In There!

Last November I did a post: To the Congressional Budget Office: Please Keep Playing it Straight!

In it I said:
I hope the CBO doesn't cave to political pressure and keeps doing its non-partisan down-the-middle job.

If I hear the politicians whining and the special interests squealing about CBO's conclusions about how these cost containment "lite" proposals...don't save much money I know the CBO pros are doing their job.
I also said:
It looks to me like the nebulous "pay-for-performance" initiatives often proposed as part of Medicare physician payment reform are too often ways of avoiding the really heavy lifting that has to be done to fix that doc payment system. Since no one seems to agree on what quality is and a way to measure it I don't have a lot of faith there are big fixes here. If all of the docs are enthusiastic about pay-for-performance proposals in exchange for avoiding fee cuts you know it isn't accomplishing a lot!

Wellness programs very similar to the ones we see today were around in the late 1980s and never accomplished a lot.

Health information technology progress and patient medical records are very important--particularly for improving quality--but have a lot of upfront costs and take years to payoff. Ask any doctor now struggling with them.

The disease management and coordinated care programs now being proposed are, like most cost containment "lite" proposals we are seeing today, helpful but only incremental extensions for what is going on in the market anyway. No silver bullets.
So, six months later lawmakers are sending one of these "cost containment lite" proposals after another over to the the CBO and the CBO is sending them back stamped, "insufficient funds."

And there's lots of whining about it now going on atop the Hill where people are desperate to find easy money for health care reform.

It will take more than $1.2 trillion to pay for health care reform and the Obama budget cuts have only identified about $300 billion toward that goal.

We will not reform the health care system unless we really reform the health care system.

The only thing standing between BS reform and real reform are the men and women--real men and real women--over at the CBO.

Proud of you.

Hang in there!!!!


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