Larry C. McNeely II

Critics of the law’s productivity adjustments argue that we can’t expect America’s $2.3 trillion health sector to tighten its belt. They believe we can’t expect the health care industry to cut even a fraction of the $700 billion a year it wastes on things that have zero impact on patient health.

The ACA is designed on the premise that these naysayers are wrong and that American’s should expect better from the health care industry.

Under the new law, Medicare, the largest single purchaser of medical services, will test dozens of new approaches to delivering lower costs through better care. These programs begin as pilots, to be sure, but between new authorities given HHS and the Independent Payment Advisory process, the tools exist to extend these innovations across Medicare. If opponents don’t derail this process through their ill-considered repeal schemes, it will result in substantial rewards for those providers who deliver the best patient care, not just those who can bill for the most procedures and tests

If America's health care system is to seriously address its cost and quality challenges, the Administrator of the Center for Medicare and Medicaid Services (CMS), charged with guiding new payment and delivery reforms, will play a vital role.

By choosing Dr. Donald Berwick, the Obama administration has chosen a real leader who has built his career doing exactly what CMS must now accomplish: helping health care institutions cut costs while improving quality of care. It’s a goal that a wide range of constituencies and the American public support. It should have the support of political leaders of all stripes.

This task and this appointment should not have been so controversial. That it has become one is seriously disappointing for anyone, liberal or conservative, who cares about the cost and quality of our health care.

True to form, Washington has turned recent highly technical rule-making around grandfathered health insurance plans into an opportunity for political point-scoring. Opponents of reform say the new regulations shatter the President's promise to allow happy customers to keep what they have. Supporters characterize the new rules as keeping faith with that promise.

The truth is a little more complex.

Implementing the new law requires striking a balance between steps to ensure that all American consumers receive some basic protections and preserving the stability of the employer market over the short term. Steer too strongly in one direction and employers will just drop coverage rather than meet new standards. Steer too strongly in the other, and employers will have every incentive to maintain coverage but gut the benefits and coverage they offer.

The administration's interim final rule, issued last week, seeks to strike the right balance.

In the short term, the upshot is that those consumer protections that are most popular with the public and least exp

As the budget experts at the Congressional Budget Office remind us, health care costs in America are on an upward trajectory that we simply cannot sustain. Unless our health care system wrings better value from the dollars we are spending on health care, rising costs will force us to confront terrible choices in the future… about who to drop from insurance roles, about what services have to be cut.

Accountable care, wherein providers work together and are compensated for improving the health of a defined set of patients, is the off-ramp from today’s unsustainable path. Its pioneers, Geisinger, Intermountain, and the Mayo Clinic, deliver care that costs as much as 41% less than the national average. They do this not by skimping on care, but by delivering care better.

To help spread these approaches, this year’s health reform law provides for a shared savings program within Medicare that will nudge more health care providers toward accountable care models. It is heartening that the national hospital al

Mr. Goodman contends that these plans cut costs. But the question is – for whom do they accomplish this laudable goal?

High deductible plans cut costs for insurance companies because the consumer is then stuck paying a massive out-of-pocket deductible and providers bill the patient, not the insurer, for the first several thousand dollars each year. High deductible plans cut costs for employers because workers are essentially on their own for the first several thousand dollars worth of medical expenses, decreasing overall premiums and the employers’ share. The young and healthy will see lower premiums too, because sicker patients generally have enough sense not to enroll in a plan with a huge deductible.

But there’s a catch.

The oft-cited RAND study finds that cost sharing not only reduces use of unnecessary health services, they also reduces necessary care as well. That means that by the time beneficiaries reach the deductible, and can afford to access all the ca