Newtown, CT – December 2, 2016
If anyone had any doubts that the political pendulum is swinging to a Jeffersonian model of governance, the appointments of Representative Price and Ms. Verma should lay them to rest – It’s somewhat fascinating to see how the original differences in world views expressed over two centuries ago continue to shape American politics today. For the past eight years the Madisonian model had the upper hand, with the federal government clearly at the country’s steering wheel, dictating the course that had to be taken. That will change during the term of the next presidency and the Jeffersonian model will take the upper hand, which means that states’ actions will determine what happens to most Americans. To a large extent, it was time for the pendulum to swing, because the level and breadth of innovation that we need to see happen in health care can only come from the field. States, however, will need help, benchmarks, and compendia of best practices and lessons learned to be successful. They will also need the active support of the federal government to ensure that the direction they set isn’t contradicted by the actions of Medicare or other agencies. Since Ms. Verma has been on the receiving end of the Madisonian model of government, we can venture a guess that she will try and support states as best she and her agency can. Our report cards on price and quality transparency suggest, however, that there should be strings attached to that support.
What this means to you – Earlier this year we released our fourth annual price transparency report card, which showed that the availability of pricing information for consumers in most U.S. states is dismal. A recent report funded by the New York State Health Foundation shows that generally available price transparency tools in that state need work, and that many of the tools supplied by health plans equally need some work. This week we release our annual physician quality transparency report card and it’s pretty dismal as well. As states embark on a greater leadership role, encouraged by the new Administration, there must be serious accountability for providing consumers access to reliable and comprehensive information on the price and quality of care. As proponents of consumer activation and self-directed choice, Representative Price and Ms. Verma must understand the essential importance of transparency, and should make the availability of data a condition for the federal government’s support to state innovation in payment and delivery system reform. And for those who think that it’s too hard to measure physician quality without imposing a significant burden, you can read up on the report we published a year ago, and look at the example we submitted in this year’s price transparency report card (page 15). It’s not difficult. It’s just that most States have been unwilling to take the needed leadership role in this area. So take note, because the pendulum will swing again, and the speed with which it will swing back is entirely a function of what states will do and won’t in the next few years. If our report card of 2020 looks like this year’s, make way for Madison.