Scarecrow's title is very misleading. With the possible exception of bundled payments for inpatient (that is, hospital) services, there is no reason to think the "reforms" referred to in the summary from Waxman's committee that Scarecrow quotes will contribute to cost containment UNLESS they lead to widespread denial of necessary medical services. Some of these proposal may well do that.

Some of the "reforms" (such as hiring more nurses to help chronically ill patients learn to manage their diseases better, a reform all gussied up with the pointless metaphor "medical home") will improve the health of some patients, but the cost of the intervention (in this case the hiring of more nurses and other activities that are supposed to go on in "homes") have already been shown in most pilot projects to match or exceed the savings due to improved health of patients.

Other "reforms" Scarecrow cites are just new forms of managed care. "Payment models," for example, no doubt refers to some form of "capitation," the payment method that HMOs popularized in the 1970s and 1980s. Or perhaps it refers to the latest rage in establishment health policy -- "pay for performance" -- which means bureaucrats prepare crude report cards on doctors and hospitals (much as Bush prepared crude report cards on schools) and reward "good" providers and punish "bad" providers. ACOs refers, I presume, to "accountable care organizations," a new euphemism for HMOs. The "measurement tool" that will be used to inform doctors about how many tests they order compared with the average for their location is just a reincarnation of "profiling," something the HMOs pioneered.

These Managed Care 2.0 "reforms" will probably work the way traditional managed care worked -- they will drive up the administrative costs of the system, reduce access to medical care for some patients (especially services to more vulnerable patients and services for which guidelines are hard to write, such as home care services, stroke rehab services, and treatment of mental health problems), damage quality of care more than they enhance it, and have no net effect on costs or even raise costs.

The House bill and the Senate HELP committee bill are already riddled with with numerous expressions of Managed Care 2.0 theology. I'm surprised Waxman felt he had to burden the House bill with even more experiments in unproven managed care tactics.

America is going through a hideous deja vu experience. We're seeing the old HMO experiment recycled with all the same rhetoric and false diagnoses of the problem we endured between 1970 and 1973 when the modern health care reform debate began, and when the Nixon White House and Congress cooked up the doomed experiment with HMOs. The unholy alliance that persuaded Nixon and the Democrats back then to promote HMOs(the insurance industry, big business, and some policy entrepreneurs like Paul Ellwood and Alain Enthoven) looks very much like the unholy alliance promoting Managed Care 2.0 today.

If we don't stop it, we will look back on the days of Managed Care 1.0 as a picnic. During the heyday of Managed Care 1.0 -- about 1970 to 1995 -- it was the insurance industry that wielded the basic tools of managed care (financial incentives to doctors to deny care, utilization review of doctors by HMO bureucrats when financial incentives didn't "work," and limited choice of provider). The unholy alliance promoting Managed Care 2.0 today wants the government, especially Medicare, to play a much more active role in creating financial incentives to deny care and in meddling in the doctor-patient relationship.

There are so many reasons to dislike the House and Senate HELP bills. It's hard to say which ranks as my most important reason for disliking these bills. I guess the fact that both bills funnel hundreds of billions of dollars to the insurance industry and almost no dollars to the pathetic little "public options" is my number one reason. But right behind that is my horror at the brave new world of managed care that is being cooked up for us while we sleep.

On the other hand, maybe my number one reason for disliking these bills should that when the Managed-Care-2.0 tactics fail and infuriate the public, Americans won't just point the finger at insurance companies. They will point them at "government," and in particular the Democrats who promoted this stuff.

All this to keep single-payer out of the picture...it's like SP is a terrorist plot or something.

Or even in the past eight years?