America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System

by Steven Brill

this was emblematic of the understandable tension between the two sides: The economic team wanted to use reform to bend the cost curve. DeParle and her healthcare reform policy team, including Lambrew at Health and Human Services, wanted to expand coverage. If some cost-cutting provisions helped to make coverage reform more fiscally palatable to Congress, that was a plus. But if any of the economic team’s ideas were likely to face so much opposition from any sector of the industry that Congress would run for cover, that was a negative. DeParle had included a half page describing three of Zeke Emanuel and Bob Kocher’s cost-cutting ideas, such as promoting the “efficient use of technology” by, among other things, analyzing the cost-effectiveness of new medical technology, and data “registries” for all devices and drugs that would track the results they produced in one database in order to weed out those whose results did not justify their costs. That was the most far reaching—and, given the lobbying clout that would be arrayed against it—the most far-fetched idea that DeParle included. However, DeParle had left out what the economic team considered to be some of the more important game changers, but ones that more left-of-center reformers had always been wary of: medical malpractice reform, tough penalties for hospitals with high patient readmission rates, and a push to allow hospitals and doctors to consolidate their services into “bundled payments.” Emanuel and Kocher also...