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This is a very important point by Drew Altman, CEO of the Kaiser Family Foundation:
We could be headed for a new schism in the debate about health reform...For one group, I will call them the "Delivery System Reformers," true health reform lies in making the actual delivery of care more cost effective over the long term. Delivery System Reformers champion health IT, comparative effectiveness research, practice guidelines, and payment incentives to encourage more cost-effective care such as pay for performance. They believe that only if we can weed out unnecessary care, promote more cost effective and scientifically proven therapies, and distinguish between new technologies that produce new benefits and not just new profits will we be able to get a handle on health care costs and produce value for the health care dollar. The recent op-ed in the New York Times by baseball executive Billy Beane, Newt Gingrich, and John Kerry exemplified the delivery system reform movement, and notably did not mention the uninsured once. Indeed some delivery reformers believe it would be a mistake to put more money into the current system through expanded coverage until more fundamental changes in the system are made. The other group, I will call them the "Financing Reformers," is focused on an entirely different set of problems. Its major concern is the problem of the 46 million Americans without health insurance coverage and the serious problems all Americans are having today paying for health care and health insurance. For these reformers the health care crisis is fundamentally a problem of economic security and ensuring that everyone has access to affordable health care. Financing Reformers may differ on solutions -- tax credits, expanding public programs, building on the existing employment based system, single payer -- but their primary objective is to fix what they see as a growing crisis in the health insurance system that harms people's economic well-being and access to care.Obviously many in our field advance both agendas simultaneously, but there are also two very distinct camps. They think about different problems and often attend different conferences. The health reform field is like a Venn diagram with circles that intersect (though not by a lot).As Altman goes on to argue, the two agendas fit neatly in a comprehensive reform package. Coverage expansion isn't sustainable unless cost growth is slowed. Cost growth can't be slowed without delivery system reform. Ergo, coverage expansion, in the long-run, requires delivery system reform. But if the zone of opportunity narrows and a comprehensive reform is jettisoned for an incrementalist package, you could see a real battle between those who want to spend political capital on deliver system reform (which means overcoming opposition from entrenched medical industry interests) and those who want coverage expansion (which means overcoming opposition from Republicans and budget hawks). That would be a Bad Thing.Incidentally, for a good introduction to delivery system issues, you could do worse than downloading CAP's recent book, Reforming the Health Care Delivery System, which features chapters on most all the major issues, and also happens to be free.
