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• Contrary to repeated claims by Speaker Pelosi, create a new taxpayer subsidized “Public Option” that would quickly lead to a rush from private coverage and to the cheaper public plan – resulting in the demise of private insurers.
• Force companies to purchase a benefit plan prescribed by the federal government and require that the insurance be purchased through a new national central insurance exchange.
• Require many smaller companies who today don’t provide insurance for employees to do so, or pay a fee equal to 8 percent of their payroll. (Larger companies spend about 15% of payroll on health care. Why would any company not opt for the 8% penalty, drop coverage and let employees go to a public plan, costing several million dollars a year at taxpayer expense?)
• Significantly increase the growth rate for healthcare spending, contradicting one of the major objectives put forward by those sponsoring the legislation.
• Establish huge new bureaucracies beyond those that already exist to manage pieces of America's health insurance system.
• Fail to deal with the glaring need to change from fee for service to bundled payments by treatment episodes. If you pay for procedures, that's what you get, lots of procedures, all piled into out-of-control, inscrutable bills.
• Not include reasonable deductibles and co-insurance in any of the schemes. No system will keep costs in check without the full engagement of every individual in the system. Free lunches are always expensive.

[A] diverse cross section of experts says the legislation lacks the more far-reaching structural changes needed to ensure that over the long term the nation gets its money's worth.

…. Achieving Obama's goal, say Orszag and other experts, requires covering every American, digitizing records, encouraging healthy behaviors and, perhaps most important, rewarding medical teams that deliver evidence-based care rather than those with the highest volume. It means focusing on chronic illnesses, reducing costly hospital and specialist visits, and nudging doctors to work in teams.

Many of the concepts have made appearances in the unfolding congressional drama, but they are largely cameo roles. The debate over cost controls has become a central dilemma slowing progress on the president's top legislative priority. [Emphasis is mine.]

• Emphasize and incentivize wellness, prevention, personal responsibility and the efficiency and accuracy of electronic medical records.Incentivize Americans to make their own health care decisions.
• Eliminate or modify deductibility of employer health benefits; provide a refundable tax credit per individual or per family.
• Create State Health Insurance Exchanges to give Americans a one-stop, transparent marketplace to compare different health insurance policies.
• Give states the ability to band together in regional pooling arrangements, reinsurance markets or risk adjustment mechanisms to cover those deemed ‘uninsurable.’
• Reform Medicare to eliminate waste, control utilization and increase cost-effectiveness.
• Reform Medicaid by structuring it to decrease costs and increase quality; copy states that have had success in these areas.
• Provide improved access to insurance through modified community ratings, whereby preexisting conditions would not be used in underwriting, but age and geography could be considered.

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