Senate health reform bill pushed by Obama budget chief

Washington -- The Senate health reform bill as introduced would set a more sustainable course for the American health system, although its success ultimately would depend on the effectiveness of its implementation, said Peter Orszag, PhD, director of the White House Office of Management and Budget.

Orszag said the bill's proposed Medicare commission, tax on high-cost insurance plans and delivery system reforms -- including an emphasis on comparative effectiveness research -- are important provisions that would help control health spending and improve quality. Senators began debating the Patient Protection and Affordable Care Act on Nov. 30.

"Too much of the health care services delivered in the United States are not backed by evidence that they work better than an alternative," he said at a Dec. 2 breakfast for Washington health care reporters sponsored by Health Affairs. "We need incentives for quality so that we can move toward a system that emphasizes making people better rather than have more things done."

Orszag defended the Senate bill's independent Medicare commission, which would be charged with issuing plans to control program spending. The American Medical Association opposes the board in part because it would have jurisdiction over physician payments while payment for other Medicare participants initially would be exempt.

Orszag said the Medicare commission would be able to test payment revisions and other changes, allowing program reform to progress more quickly than under congressional supervision alone. "You are creating an infrastructure for continuous improvement."

But he noted that national medical liability reform -- a provision not in the Senate bill -- would not significantly lower health care spending, citing Congressional Budget Office estimates. The same is true for allowing interstate purchase of health insurance, he said. "The CBO says both of those things would have very, very modest effects on costs and quality."

Adopting national legislation would not be considered a success unless its implementation proves effective, Orszag said. For instance, Massachusetts' health reform -- the basis for many of the Senate bill's provisions -- had a more dramatic take-up of health coverage than expected, he said, in part because the state created an expectation that everyone should have health insurance.

The penalties for not having health coverage proved less important, he added.