Steve Kagen

A House aide has said that Steve Kagen, a democratic congressman from my parent's district, is vowing to vote against ANY health care bill coming out of the House.

A House aide working for a progressive member tells me that Kagen has commented repeatedly on “value-based reimbursement,” in other words moving away from fee-for-service medicine, which tends to give doctors a financial incentive to call for more tests and more treatment, driving up costs. There are substantial pieces of delivery system reform in the bill, though perhaps not to Kagen’s specifications. “It’s unconscionable to use that as a veto,” the aide said. “Except for the public option, there’s nothing objectionable here that should cause anything in favor of reform to vote against the bill.” As the aide put it, this is something of a fig leaf, to pick the fee-for-service issue as a cover for not wanting to take a tough vote in a tough district. It’s certainly possible that this is a principled argument, and with Kagen being a former doctor he may have strong views on the subject. But there is some disconnect between such a stand, the fact that the bill includes many of these delivery system reforms, and the swing district in Wisconsin that Kagen represent. It’s certainly worth being suspicious of tangential arguments from people who claim to be supportive of reform.

I really don't know how he could vote against a bill that supports 9 out of the 10 reforms on his checklist, although I'm sympathetic to the idea of a much more value-based system -

First, we must change the nature of health insurance competition. Insurers, whether private or public, should prosper only if they improve their subscribers’ health. Today, health plans compete by selecting healthier subscribers, denying services, negotiating deeper discounts, and shifting more costs to subscribers. This zero-sum approach has given competition — and health insurers — a bad name. Instead, health plans must compete on value. We must introduce regulations to end coverage and price discrimination based on health risks or existing health problems. In addition, health plans should be required to measure and report their subscribers’ health outcomes, starting with a group of important medical conditions. Such reporting will help consumers choose health plans on the basis of value and discourage insurers from skimping on high-value services, such as preventive care. Health insurers that compete this way will drive value in the system far more effectively than government monopolies can....

Fourth, we need a reimbursement system that aligns everyone’s interests around improving value for patients. Reimbursement must move to single bundled payments covering the entire cycle of care for a medical condition, including all providers and services. Bundled payments will shift the focus to restoring and maintaining health, providing a mix of services that optimizes outcomes, and reorganizing care into integrated practice structures. For chronic conditions, bundled payments should cover extended periods of care and include responsibility for evaluating and addressing complications.