David Cutler admits that we are all guinea pigs in a grand experiment about health care. While Cutler claims the actuaries at Medicare and the Congressional Budget Office (CBO) haven’t caught the vision of our new health care law, he shows how parlous that vision is. Check out his response to me and others who have publicized the Medicare actuary’s estimate of the effects of the new law — an estimate Nancy Pelosi would not wait for.
There are no controlled trials of large-scale payment innovations of the type envisioned in the health reform law. Thus, the CMS and CBO actuaries did not know how to evaluate the likely savings from them. In both cases, this translated into an assumption of essentially no savings.
Those of us who disagree?and there are a lot of us?now have the chance to prove the skeptics wrong. We get to show that we can create a higher quality, less expensive health care system. If we are right, then costs will fall more rapidly than expected. Since the coverage expansions are already paid for through traditional payment reductions and revenue increases, all of the incremental savings can be used for deficit reduction, with perhaps some for expansions in subsidy amounts.
If we are wrong, we still have the traditional savings from Medicare reform to balance costs in the first decade. But in any case, arguing over the likely effects of reform is now irrelevant. The country made its decision on health care a month ago. People believed that cost savings were feasible, and that the strategy for realizing them was the right one. It?s time to turn belief into reality. [emphasis added]
“We get to show…we can create…. If we are right…” Really inspires confidence doesn’t it?
