This blog has spent a lot of time over the years digging through the details of this or that health care plan. But it's worth taking a moment to appreciate that the language in today's budget is something entirely different: Not an idea, but a directive. Not a document to win a campaign, but a document to kickstart the congressional process. This is what health reform looks like. This is happening. As reported here earlier in the week, the budget document does not offer a detailed plan. Rather, it's partial funding paired with detailed principles. The money is significant: $634 billion over 10 years. It comes from limiting the itemized deductions upper income Americans can use to lower their tax bracket and squeezing the private insurance providers who are charging Medicare 114 percent what the program traditionally spends. It comes from accelerating the adoption of generic drugs and changing hospital payment policy to reduce the need for follow-up visits. According to documents obtained by The Prospect, the budget also says that "the President looks forward to working with the Congress over the coming year, and as he does, the President will adhere to the following set of eight principles:"
• Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. People will be allowed to keep their own doctor and their employer-based health plan. • Make Health Coverage Affordable. The plan must reduce waste and fraud, high administrative costs, unnecessary tests and services, and other inefficiencies that drive up costs with no added health benefits. • Protect Families' Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness. • Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments. • Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions. • Aim for Universality. The plan must put the United States on a clear path to cover all Americans. • Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology with rigorous privacy protections and the development of data on the effectiveness of medical interventions to improve the quality of care delivered. • Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.
The principles do not shock. Preservation of choice comes first, a nod to the attacks lobbed against the Clinton plan and a blow to supporters of single payers. "Affordability" and "financial health" should be understood as answer a question that has been, I'm told, central to the health teams' deliberations: What are we doing for the insured? They mean to sell this plan not just as a rescue package for the uninsured but as aid to the 85 percent of Americans who currently have health care coverage. "Aim for universality," which is language reported by this blog on Tuesday, is a key directive: Testifying before the Senate Finance Committee yesterday, CBO Director Doug Elmendorf said universality "would require mechanisms for pooling risks, subsidies to make health insurance less expensive, and an enforceable mandate." Finally, the administration is committed to a plan that's revenue neutral. Either it saves enough money to pay for itself, raises enough money to pay for itself, accelerates productivity sufficiently to pay for itself (an interesting option that I'm going to get more details on), or, more likely, does some combination of the three. But it won't be deficit financed, at least not if they can help it. And that, basically, is where Congress begins. This budget release has broad outlines: The full budget, which comes in April, might provide somewhat more detail. But the administration has now passed the ball to Congress. The question is what Congress does with it.
