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EXECUTIVE SUMMARY:  In September 2009, we released a set of concrete, feasible steps that could achieve the goal of significantly slowing spending growth while improving the quality of care. We stand by these recommendations, but they need to be updated in light of the new Patient Protection and Affordable Care Act (ACA).


Reducing health care spending growth remains an urgent and unresolved issue, especially as the ACA expands insurance coverage to 32 million more Americans. Some of our reform recommendations were addressed completely or partially in ACA, and others were not. While more should be done legislatively, the current reform legislation includes important opportunities that will require decisive steps in regulation and execution to fulfill their potential for curbing spending growth.


Executing these steps will not be automatic or easy. Yet doing so can achieve a health care system based on evidence, meaningful choice, balance between regulation and market forces, and collaboration that will benefit patients and the economy (see Appendix A for a description of these key themes).


We focus on three concrete objectives to be reached within the next five years to achieve savings while improving quality across the health system:


    1. Speed payment reforms away from traditional volume-based payment systems so that most health payments in this country align better with quality and efficiency.


    1. Implement health insurance exchanges and other insurance reforms in ways that assure most Americans are rewarded with substantial savings when they choose plans that offer higher quality care at lower premiums.


    1. Reform coverage so that most Americans can save money and obtain other meaningful benefits when they make decisions that improve their health and reduce costs.


We believe these are feasible objectives with much progress possible even without further legislation (see appendix B for a listing of recommendations). However, additional legislation is still needed to support consumers – including Medicare beneficiaries – in making choices that reduce costs while improving health.

Michael Chernew

Leonard D. Schaeffer Professor of Health Care Policy and Director of the Healthcare Markets and Regulation Lab - Department of Health Care Policy, Harvard Medical School

Dana Goldman

Leonard D. Schaeffer Director's Chair - Schaeffer Center for Health Policy & Economics

Distinguished Professor of Public Policy, Pharmacy, & Economics - Sol Price School of Public Policy and USC School of Pharmacy

Nonresident Senior Fellow - Economic Studies, Center for Health Policy

Bob Kocher

Partner - Venrock

Former Brookings Expert

Senior Fellow - USC Schaeffer Center for Health Policy & Economics

Mark B. McClellan

Former Brookings Expert

Director, Margolis Center for Health Policy - Duke University

Leonard Schaeffer

Judge Robert Maclay Widney Chair and Professor - USC Schaeffer Center for Health Policy & Economics and USC Price School of Public Policy

Trustee - University of Southern California

Trustee - The Brookings Institution

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