The trouble with pilot programs
GAIL WILENSKY: Pilot programs. It's absolutely true we don't know how to get from a -- a system where most physicians are paid on a fee-for-service basis, each individual service that's provided, to paying for taking care of somebody with diabetes, or to pay all the physicians that take care of somebody who is having a bypass procedure or a hip replacement.
That's called a bundled payment. We need to experiment how to do it. But our history with pilots is that, if there is not the authority up front to implement the pilots that work, they're not likely to actually find their way into action. And that's a big problem.
JUDY WOODRUFF: And this is an authority that I believe you think should be -- should reside in the office of the secretary of health and human services.
GAIL WILENSKY: Absolutely.
JUDY WOODRUFF: And my question, though, on that is that, you know, many on the Republican side of the ledger say, that's too much government control.
So, this argument that you need somebody with authority who represents the federal government flies in the face of the argument from Republicans you have already got too much government control in this plan.
GAIL WILENSKY: Well, Medicare is already paying how hospitals are paid, how physicians are paid. The question is, can we pay smarter, we -- and have incentives to provide the health care that people need, have it be evidence-based, but not just pay for more and more complex, if that's not actually the most medically appropriate?
We know what we have now doesn't work. We can see that by our unsustainable spending and our poor value. The question is, when we figure out what works, how do we get that actually into action? The secretary is an accountable person, accountable to the American public. The secretary can be dismissed, if the person gets completely out of line.
That's the better way, to my mind, rather than a Medicare commission, which, once appointed, is not accountable to anybody. So, we need to find a way to get the pilot programs that show we can improve quality and reduce spending actually into action. There's a long history of pilots that never go anywhere.
JUDY WOODRUFF: There are so many threads to all of this, and -- and we don't have time right now to get into all that. But what about coming down -- down to the way many people relate to the health care system? And that is through the premiums that they pay for their insurance.
We heard Peter Orszag say that he thinks those will go down. How do you see that?
GAIL WILENSKY: Well, for some people who haven't been able to get insurance or only very expensive insurance because they're uninsurable, their premiums may go down.
But for a lot of people, they actually may go up. It will depend exactly how many of the 50 percent of the population without insurance comes in. One of the troublesome parts is that, if you guarantee you can come in whenever you want, you can't be penalized if you have a preexisting condition, can't be denied insurance, some people may wait until they're sick.
If that happens, if very many of those people wait until they're sick to get insurance, it will actually drive up costs for all of us. It's a little of what happens in New York.
JUDY WOODRUFF: Bottom line, Gail Wilensky, you're concerned that this legislation doesn't do enough to address the rising cost of health care?
GAIL WILENSKY: Absolutely. Does a good job in reforming insurance that is cost containment-lite at best.
JUDY WOODRUFF: Gail Wilensky, thank you very much.
GAIL WILENSKY: Thank you.