Cutting costs

CUTTING COSTS…. Just a few days after David Broder argued the Democratic health care reform plan may not cut costs enough, David Brooks makes a similar case. Despite all evidence to the contrary, the NYT columnist argues, “Instead of reducing costs, the bills in Congress would probably raise them.” Brooks concedes that Dems “have tried to foster efficiencies,” but he doesn’t expect them to succeed in “fundamentally bend[ing] the cost curve.”

Perhaps the Davids should take the time to read this Ron Brownstein piece, published over the weekend, on the ways in which the reform plan would cut costs. The White House has been circulating Brownstein’s item, and for good reason — it’s an important piece.

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won’t succeed unless it “bends the curve” in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

“I’m sort of a known skeptic on this stuff,” Gruber told me. “My summary is it’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here….I can’t think of anything I’d do that they are not doing in the bill. You couldn’t have done better than they are doing.”

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. “The bottom line,” Nichols says, “is the legislation is sending a signal that business as usual [in the medical system] is going to end.”

If we’re going to be intellectually honest about this, the truth is, reining health care costs is extremely tricky. No one can say with any confidence exactly what might to work and what might not. Brownstein gets into some wonky details about the competing provisions, which are worth reading to appreciate the larger policy fight.

The point, however, is Democratic leaders are pursuing all kinds of measures intended to bend the cost curve. Chances are, some will work well, some won’t. But the key is what Gruber told Brownstein: “I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made.”

The idea is to put the best ideas in the legislation, make a genuine effort to get costs under control, and see what’s effective.

The funny part of this, in a way, is that Republicans should be applauding these efforts. This is their signature concern, right? Cutting costs? Saving money? Fiscally responsible policymaking? It’s likely one of the reasons so many Republicans who aren’t in office have already expressed support for the effort.

As Ezra Klein explained the other day, “If this piece of the bill was passed on its own, it would be the most important cost control bill ever considered by the United States Congress.”

Also, Kevin Drum noted that the Senate bill is the most “ambitious” attempt to “rein in both Medicare costs, and healthcare costs generally, than anything ever done. Nothing else even comes close.” He added that Reid’s measure may be the “best prospects for healthcare cost control we’ve ever seen.”

That’s clearly, demonstrably true. If the public understood this, and there was a broader recognition that Republicans were needlessly attacking the most ambitious cost-savings package in American history, perhaps the debate would be less ridiculous.