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Writing New Prescriptions For Change
President Lyndon Johnson signs the legislation that created Medicare and Medicaid on July 30, 1965
(By The Associated Press)
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At this point, however, few lawmakers seem to know where to start tinkering with a health-care system so vast and so complex -- and so critical, as Bernanke put it, to "economic growth, wages and living standards, and government budgets."
"I wonder if we're competent to answer some of the questions we're being called upon to legislate," Baucus mused yesterday.
That's where the newly beefed-up policy shops and think tanks aim to help. Under McClellan, the new Brookings center is evaluating and providing technical assistance to state programs, particularly those that try to do a better job measuring the quality and cost of care.
In 1994, "a lot of the focus was on financing and how to provide new subsidies and access to affordable health insurance. Now the focus is going to be much more on reforming health care itself, because that's all we can afford to do," McClellan said.
The Congressional Budget Office, meanwhile, is compiling a two-volume compendium of critical issues and options for health-care reformers, focusing closely on costs to the federal budget.
"There is increased analytical effort being dedicated to this topic in a variety of settings, including at CBO," said director Peter Orszag, whose health team is poised to grow from 30 to 51 people in less than a year. "Frankly, at this point, one constraint is finding the types of highly qualified people that we need for the effort. A lot of us are very actively recruiting."
Will the next administration do something big and bold? Orszag declined to speculate. Others predicted that, regardless of what the White House wants, lawmakers will go slow, preferring a piecemeal approach that makes small changes to expand coverage.
"Anything big is really extremely expensive or extremely disruptive or both. And there's no consensus on what the big thing should be," said Jim Jaffe, a longtime aide to former congressman Dan Rostenkowski (D-Ill.) who survived two rounds of health-care reform and now serves as vice president for public affairs at the Center for the Advancement of Health. "We aren't ready to cut the cord on the employer-provided system, Ron Wyden notwithstanding."
But others see an appetite for far-reaching reform.
"There's a broad-based desire to do more to make health care more accessible and more affordable," McClellan said. "If all that happens is some incremental reforms, that would be a missed opportunity."
