As regular readers of HealthBlawg are well aware, I had my doubts that el Presidente could pull it off once the Dems lost Kennedy's Senate seat, but he did manage to rally the troops and get the sausage version of health insurance reform enacted. Nothing to sneeze at, but it's only a first step — health insurance reform, not a full health reform package as promised during the campaign.
Nevertheless, the steps to be taken towards implementation of health reform remain the same — even though we do have legislation in place, and a nominee (finally) — Don Berwick — to head CMS. (See more on the pros and cons of Berwick's nomination, and a podcast interview with Berwick here on HealthBlawg from about 18 months ago.)
In brief, with or without the legislation — and many, many other sources have posted summaries of the legislation, so I will not be doing that here — the federales and other players need to continue to do three things:
- Federales: Design and run meaningful pilots and demonstration projects, and mainstream successful ones as soon as possible;
- States: Continue to act as laboratories for experimentation in health care reform; and
- Private and Public Sector Employers: Continue to experiment with and implement new approaches to health care financing and delivery — e.g., patient-centered medical home and value-based design — that can and do lower costs and improve quality.
Now the fun begins.