Word: costly
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Dates: during 2000-2009
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...these days, Obama isn't saying much about cost-cutting. This is partly because most of his curve-bending ideas - computerized records to bring medicine into the 21st century, comparative effectiveness studies to identify unnecessary treatments, revamped incentives to reward quality rather than volume of care - would take more than a decade to start slashing costs, and the Congressional Budget Office (CBO) doesn't score bills for their impact on the federal deficit that far in advance. Obama's most prominent game changer - an independent panel to set Medicare reimbursement policies removed from political pressures - did not fare well under...
Politics, of course, is the main reason Obama is trying to sound more like Santa and less like the Grinch. Cutting costs ultimately means cutting payments to drugmakers, hospitals, doctors, insurers and other influential health lobbies, so it's understandable that he hasn't dwelled on it. Providers like the Mayo Clinic have demonstrated the promise of high-quality, low-cost care, and mounds of research as well as books like Shannon Brownlee's Overtreated have documented Orszag's less-would-be-better thesis. But to laymen it can still sound like typically empty government promises to weed out waste...
...Obama political team has concluded that cost inflation is mostly a Beltway issue, that August recess requires reform to be marketed in more personal terms: What does it mean for you? It would be nice if Obama stopped limiting his answer to that question to consumer protections against rapacious insurers. It could be: Your premiums won't double every decade, your economy won't sink and your government won't go broke. Then again, David Axelrod probably deserves the benefit of the doubt when it comes to selling reform...
...reform won't be worth selling if it doesn't include real cost restraints, and the early versions floating around Capitol Hill have been a bit disappointing. Obama has promised that reform will shift medical incentives from quantity to quality, from paying for volume to paying for outcomes. But except for a couple of demonstration projects designed to investigate why care costs so much more in some parts of the country, that hasn't been the focus of congressional legislation. "We've got to get the incentives aligned, or else we'll keep punishing excellent care, and we'll keep...
...thing not to emphasize cost-cutting because you think it's a political loser. But it's another thing not to do cost-cutting because you think it's a political loser. If reform simply expands a system of unaffordable care, then the town-hall crazies will have a legitimate point. Then Obamacare really will make the crisis worse...