Moves to Fix Health Care Delivery

The healthcare happy talk is over. Just as the spring flowers are starting to bloom, so is the inevitable controversy over efforts to overhaul the nation's $2 trillion-a-year healthcare system.
Tops on the list is whether to pursue the effort through the budget reconciliation process. Republicans -- and some deficit-hawk Democrats -- view the fast-track procedure as a way to effectively cut them out of the process, since a reconciliation bill is protected from Senate filibuster and needs only a simple majority to pass.

Battle lines are also being drawn over whether a health bill should include a new public plan that would compete with private insurers.

Republicans say the government plan would have too big an advantage. Said Senate Finance ranking member Charles Grassley at the White House health summit last month: "There's a lot of us that feel that the public option -- that the government is an unfair competitor and that we're going to get an awful lot of crowd-out."

But Democrats are equally adamant that the public option be included. Sen. Bernie Sanders, I-Vt., at the Health, Education, Labor and Pensions Committee's confirmation hearing for Kansas Democratic Gov. Kathleen Sebelius to head HHS this week said: "I think that at a time when approximately 30 percent of every healthcare dollar spent through a private insurance company ends up in administration, profiteering, advertising or whatever, that so long as we remain dependent on private insurance companies, we're never going to have quality, cost-effective health care for all Americans."

Despite the budding discord, however, there's something major that differentiates this round of health debate from the last round. It's a bipartisan consensus that whatever happens with access and coverage, one thing that must happen to get healthcare spending under control is an overhaul of the way health care is organized, delivered, and paid for in this country.

"Delivery system reform" might not sound sexy, and might not mean much to anyone outside the world of health policy. But in the end, it might be the glue that binds together a consensus on a bigger health bill.

To put it in medical terms, the key problem with healthcare delivery in the United States is that it's too fragmented. "Each individual provider is generally on their own," says Elliott Fisher, who heads the Center for Health Policy Research at Dartmouth, which is famous for identifying the huge variations in amounts of care patients receive depending on where they live. "We do not have a system that supports effective communication between providers, or effective transitions between the hospital and home."

As a result, he says, patients often see multiple physicians who don't communicate with each other, resulting in tests being repeated, or diagnoses being missed. That doesn't serve patients or providers very well.

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