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A strong public plan would give the government more power to change the payment system that currently pays for quantity (procedures), rather than for quality (better health outcomes).
Therefore, changing the financial system by altering incentives will alter the behavior of many providers. This will therefore indirectly reform the health care that many receive from their GPs. While this could lead to rationing (if payments are simply cut), it could also lead to better coordination between providers and more time spent on well visits, communication, etc. if new forms of payment are introduced by a government payer with more purchasing power (such as the yet to be defined accountable care organization, medical home, more pay for performance, capitation under a new name, etc.).
Because of limited resources (just 25 years ago, health care spending was something like 8% of GDP--now it's more than double that), it's simply impossible to provide quality care to everyone without changing how care is paid for. So indirectly, financing has everything to do with actual health care. Private payers generally follow Medicare as is. With an even larger governmental entity at the federal level (Medicaid practices are determined at the state level, with matching federal dollars based on a sliding scale), all the more power to dictate needed changes.
What changes are the best? That's less than exactly clear, as there was plenty of debate at the AcademyHealth Annual Research meeting in Chicago this week. Of course everyone agrees the current fee for service system is perverse and unsustainable, but good luck finding a consensus on the best new approach. Expect more demonstrations.
I guess the main thing that I'm trying to get across is that a public plan alone won't change anything. It has to be a public plan with that is aggressive in changing the way care is paid for in order to change practices at the beside in order to increase access AND improve quality. Therefore, the way health care is financed (not the cumulative dollars), is definitely health care reform. Unlike a public plan, which could happen this year, this change will take much longer. A public plan is a good mechanism to start with....
Demockracy.com