Hearing of the Senate Finance Committee Subject: Aligning Incentives: The Case For Delivery System Reform

SEN. RON WYDEN (D-OR): Thank you, Mr. Chairman. I think it's been an excellent panel. I would only say, with respect to the health care home, what we did the Healthy Americans Act, is we made it an option for the patient and the consumer. In other words, it's not going to be drilled down their throat against their will, but plans would have to make it an option. And I hope -- I think, Dr. Miller, I think that's along the lines of what you want to have is let's have some options. Let's have some flexibility and make sure that this is tested.

Obviously, what has emerged from this panel and our previous hearings is that the incentives that drive American health care today work against quality. I mean, Medicare, in effect, pays for quantity mostly rather than quality. And that's certainly true of the tax code as well. If you're really offering crummy quality health care in the United States in the private sector, don't sweat it, because the private sector is going to get subsidized through the tax code for inefficiency.

So as I look at the tools for rooting out a lot of the poor quality care and driving down the costs, it seems to me we have to make it easier for patients to compare us and shop. And I'd like to maybe start with you, Dr. Miller, and then you, Dr. Berenson. I don't think it's very easy for patients to comparison shop, either in Medicare or in the private sector, for quality and cost. Do you agree with that?

SEN. WYDEN: Well, that really get to my question for you, Dr. Steele, because I think that an approach like Geisinger, which values quality rather than just, in effect, spending their time trying to shed bad risk, is going to flourish under the Healthy Americans Act. For example, what we do in this legislation is we create a website where consumers, all consumers, Medicare, private sector, can secure quality and cost information by zip code.

So what that means is Medicare patients and say a worker with an employer-based package can look at all the alternatives. The worker can keep their employer package, if that's what they want, but they'd also be able to look at the alternatives. So my question to you, Dr. Steele, is wouldn't it be useful in delivery system reform to include changes that provide incentives to the consumer to comparison shop for private coverage?

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