The health insurance strategy should be affordable and sustainable for society

4.       The health insurance strategy should be affordable and sustainable for society: Major reform proposals will need mechanisms to control inflation and encourage use of efficacious, cost-effective services.

                                Grading Rubric 

A	B	C	D	F	Truant
Payments to providers and suppliers, and patients' cost-sharing will be linked to the cost- effectiveness and quality of services. System integration will enable implementation of mechanisms proven to increase quality and reduce cost. Total administrative costs are less than 10%.	Only two of the stakeholders (providers, suppliers or patients) have reimbursement  or cost-sharing linked to cost- effectiveness and quality of services. System integration is sufficient to impact, but not fully control, quality and cost. Total administrative costs are less than 10%.	Only two of the stakeholders (providers, suppliers or patients) have reimbursement  or cost-sharing linked to cost- effectiveness and quality of services. The system is loosely integrated. Total administrative costs are more than 10%.	Only one of the stakeholders (providers, suppliers or patients) have reimbursement  or cost-sharing linked to cost- effectiveness and quality of services. There is little or no system integration. Total administrative costs are more than 10%.	No stakeholders have reimbursement   or cost-sharing linked to cost-effectiveness and quality of services. There is no system integration. Total administrative costs are likely to be high.	No plan is offered.

 

Criteria for review: Physicians and other health care providers will play a vital role in health care cost-containment through a renewed emphasis on the stewardship of clinical resources. The cost of health care should be distributed equitably across the entire population. Any reform should minimize administrative cost, and simplify enrollment, underwriting and billing procedures. The government should be able to negotiate prices with pharmaceutical and medical device companies to ensure quality, low-cost medications for all. (This rubric does not take into account potential cost-savings from the implementation health information technology, as there is no current evidence of the magnitude, if any, of the cost-savings.)

 

Democrats

Obama: C

The Obama plan supports disease management programs, adoption of health information technology, allows drug re-importation and increases use of generic drugs.  Health insurance companies will have to disclose what percent of premiums is spent on health care versus administrative costs.  Employer health plans will be eligible for reimbursement of a portion of catastrophic costs.  This plan will enable Medicare to negotiate for the price of drugs with pharmaceutical companies and end subsidies to Medicare Advantage plans.  Reimbursement from all public plans and private plans in the Exchange will be aligned with performance on physician-validated outcome measures.  The plan received a C because the cost-cutting mechanisms are unlikely to reduce overall administrative costs to less than 10%, the system is loosely integrated and there is no provision to link patients' cost-sharing with the cost-effectiveness of the services they choose.

 

 

Republicans

 

McCain: C

The McCain plan would control costs by promoting competition throughout the health care system including between providers and among alternative treatments.  Medicare would not pay for preventable errors but would pay for care coordination.  The plan supports continued development of generic drugs and drug re-importation. The plan received a C because the cost-cutting mechanisms are unlikely to reduce administrative costs below 10% or increase the use of cost-effective services.  The plan does not offer a vision for a well-integrated system of care.