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This so-called fee-for-service tradition has contributed to the dysfunction of the U.S. health-care system. Americans buy health care the same way they buy furniture, clothes and food: one item at a time. Physicians bill by the visit; radiologists bill by the X-ray; hospitals bill by the day. That drunken spending has led to the familiar horror-story numbers: a health-care system that gobbles up 16% of gross domestic product, compared with 9% in other industrialized countries, yet leaves the U.S. trailing those countries in such critical metrics as life expectancy and infant mortality...
...this, switching Geisinger over to a prix fixe, episode-care model for surgery, starting with the heart bypass. Under the new system, a closely coordinated team of caregivers would be responsible for every stage of a bypass patient's treatment and recovery. The hospital would submit a single bill for all work and include a 90-day warranty. If a patient checked back in with a complication like a postsurgical infection, that work would be on Geisinger's dime. "We'll do it right, or we won't send a bill" was how Steele put it to his staff...
...also a masterstroke in political leverage. And no one loved Senate politics more than he. Snowe's yea earned her--a member of a weakened minority, from the lovely but not very influential state of Maine--a voice in the small group hashing out the final version of the bill. In the Senate, she is just one among 100. But on probably the biggest bill of the century, she's now one of a handful cutting the deal. When the Clinton Administration attempted to pass health-care reform, Finance was its graveyard. This time, the idea survived the committee with...
Five days later, Ignagni released an analysis by PricewaterhouseCoopers that claimed, on the basis of a misleading reading of the bill, that reform could lead to a painful spike in insurance premiums for ordinary Americans. The episode shattered the thin trust between the Administration and the insurance lobby and set the stage for an ugly and very public war over the shape of the final measure. "I feel completely misled," said the Senate aide who was on the call. "There are a couple of things you have to have in this town, and your good name is one of them...
...AHIP report was the kind of one-sided study that lobbyists sometimes commission to create scary sound bites. It worked. The report analyzed the impact of four narrow features of the Senate Finance bill using a worst-case-scenario model; it concluded, as Ignagni says, that "health care costs [would] increase far faster and higher than they would under the current system." A fairer reading of the bill, which cleared the Finance Committee on Oct. 13 with a 14-9 vote, with one Republican supporter, suggests these projected costs are wildly exaggerated. Other provisions of the bill are aimed...