This Is Part Of What We Have Been Saying All Along

May 31, 2011, 3:31 pm

Paul Krugman says in the New York Times...............................

Medicare Doublethink

Robert Pear has an interesting report today about how reforms in Medicare payments under the Affordable Care Act, designed to provide incentives for more cost-effective care, are drawing opposition from hospitals:

For the first time in its history, Medicare will soon track spending on millions of individual beneficiaries, reward hospitals that hold down costs and penalize those whose patients prove most expensive.

The administration plans to establish “Medicare spending per beneficiary” as a new measure of hospital performance, just like the mortality rate for heart attack patients and the infection rate for surgery patients.

Hospitals could be held accountable not only for the cost of the care they provide, but also for the cost of services performed by doctors and other health care providers in the 90 days after a Medicare patient leaves the hospital.

This plan has drawn fire from hospitals, which say they have little control over services provided after a patient’s discharge — and, in many cases, do not even know about them. More generally, they are apprehensive about Medicare’s plans to reward and penalize hospitals based on untested measures of efficiency that include spending per beneficiary.

A major goal of the new health care law, often overlooked, is to improve “the quality and efficiency of health care” by linking payments to the performance of health care providers. The new Medicare initiative, known as value-based purchasing, will redistribute money among more than 3,100 hospitals.

I’m all in favor of this proposal — it’s part of what must be done.

But here’s my thought: I do believe that many people in the commentary business can manage to read stories like this, tut-tut about the difficulties, and then — in the very next breath — complain that Obama is doing nothing to limit the growth of health care costs.

The point is that this is what cost control looks like. Things like the Ryan plan, which just shift the cost of care onto seniors, are fake; this is the real thing.

And it gets no credit at all.