NPR had an interesting piece regarding the shifting focus of the debate. When the President launched the effort many months ago (during the campaign, actually) the impetus related to expanding coverage for the un- and under-insured and to make health care more affordable for everyone. According to NPR: "The health bill passed by the House - and a similar measure pending in the Senate - boost the number of people covered by health insurance. But critics from across the political spectrum say the legislation does little to rein in runaway health care costs." See the entire article here.
The more recent focus has been on the payer side of health care, hence the fact that many if not most discussions now describe this as health insurance reform. Big difference. The question is: why the change?
Cynics may answer that the powerful provider lobbies (AMA and AHA) and big businesses (i.e., the pharmas and equipment manufacturers) have found a way to successful apply pressure on legislators. Maybe that's true, but I wonder if the lawmakers have rediscovered the longstanding challenges associated with reigning in health care costs. The challenges pertain to the fact that while there are some excesses and inefficiencies in this sector (show me one where there are not), cost cutting efforts quickly get into the sticky issues of negatively impacting quality, limiting choice, and restricting care to some (aka rationing - and no public figure wants that association).
Early rhetoric, including the President's, centered around driving improved quality as a way to appropriately shift incentives and lower overall costs. Evidence strongly supports this general idea, but the current House reform bill and the pending Senate one don't seem to support these concepts as much as the early arguments indicated they might.
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