First in wave of healthcare policy proposals debuts

WASHINGTON -- The first pieces of what will become sweeping legislation to overhaul the nation's healthcare system have arrived at last.

The proposals float a new payment system for doctors and a new focus on primary care and care coordination for patients.

Finance Committee Chairman Max Baucus and Senator Charles Grassley, the committee's ranking Republican, released the first of three sets of policy "options" for reforming the healthcare system this afternoon, a day before the full committee meets to begin discussing them.

This first set of "options" focus on many of the less contentious aspects of the healthcare legislation -- improving quality of care and controlling soaring healthcare costs.

The big themes include changing the way doctors are paid by Medicare to reward quality care instead of quantity of care; providing bonuses for primary care doctors and general surgeons, who are in short supply; a major push for "care coordination" in Medicare by encouraging providers to work together in caring for patients; establishing quality performance measures and a national quality improvement plan; and reducing Medicare fraud.

The proposals also call for making a stronger committment to comparative effectiveness research -- a systematic effort to discover through coordinated scientific research which treatments work best for which patients. This was a hot-button issue in the stimulus package, which set aside $1 billion for such research; the new proposals leave open the contentious question of whether the body guiding that research would be within government or a separate non-profit entity.

These will be preliminary talks -- the Finance Committee will begin shaping the bill in earnest in early June. Still, after nearly a year of hearings and meetings behind closed doors, it's a big moment.

Also yesterday, Senator Edward M. Kennedy's Committee on Health, Education, Labor and Pensions held a hearing on what lessons policymakers could learn from reform efforts in other states, including Massachusetts, Vermont, Utah and California. Witnesses from Massachusetts included Jon Kingsdale, executive director of the Massachusetts Commonwealth Health Insurance Connector Authority, and Eileen McAnneny, senior VPof the Associated Industries of Massachusetts.

At the hearing, Kennedy said the federal government must learn from efforts going on in the various states and "constantly work so the states themselves have an opportunity for success."

Kennedy's committee, which also has jurisdiction over many healthcare issues, is working on what is expected to be separate but closely related healthcare legislation; Democrats hope to eventually merge the two bills.