Pilot projects. Sure, the legislation won't begin rewarding providers for quality over quantity, and it doesn't get at the heart of our cost problems, but the answers may lie in its many pilot projects that test new reimbursement systems, medical liability models, and other potential long-term changes. If you don't believe me, Atul Gawande makes a much more compelling case.
(Eventual) payment system reform. Most physician groups aren't too keen on the idea of an independent Medicare payment commission that will have control over Medicare payment policies. That's because they've had success in lobbying Congress to prevent proposed cuts to reimbursement, and they don't want to lose that influence. But Congress' fickleness has been part of the problem. I think permanent payment reform—including a transition away from fee for service—will ultimately come from this new independent Medicare commission.
I could have easily found five flaws with the Senate bill and written about those instead, and there was a time for that. The healthcare industry was right to poke holes in the legislation and fight for an ideal bill as it was being developed.
But that stage has passed. Despite a year of smothering cynicism, this bill is better than it gets credit for and more bipartisan than politicians will admit (in substance it is more conservative than what Presidents Bill Clinton or Richard Nixon proposed in the past). It should be viewed as a first step, rather than a final solution to the healthcare system's problems.
Now we're left with a choice between an imperfect bill and the status quo, for possibly several years. The last time reform failed it was more than a decade before it again became a priority, and it could be that long or longer if history repeats itself. Unfortunately, that's how politics works these days.
Despite the missed opportunities and flaws in the process, the healthcare reform debate at this point boils down to one question: Are we better off with the current system for the next three, eight, or 16 years?