I was thrilled this morning to attend a meeting with Dr. Bob Kocher,
MD, Special Assistant to the President on the National Economic
Council who is one of the President's key people on healthcare reform.

It was extremely interesting to hear what the President is aiming for
and what their vision is.

My very rough notes - and this is very rough ...

* Must cover all people, but not in a way that causes a cost crisis
that must then be solved.

* Congress and the President have 80% agreement on most items:
- must cover everyone
- a coverage mandate
- Need a more effective private insurance market place, probably
modeled on Massachusetts Connect
- There will need to be subsidies (duh :)
- The new system will be 100% financed to begin with, and funding will
flex with the economy and the system
- The new system must maintain the employer-based system as the
primary coverage vehicle
- information must be more transparent
- the delivery system must be reformed
- the new system will be phased in over several years - NOT right away
- the new system must make the demand side (patients) seek value, and
the supply side deliver value
- the new system must align incentives across the system

* Critical path items of disagreement between the president and congress:
- the public plan concept
- definition of "basic healthcare" and how it should vary by income
- what mechanisms will ensure the preservation of the existing system;
e.g., what punishments will be put in place for employers who drop
coverage?  will this incent employers not to hire?  etc.
- Mandate penalities - if someone doesn't get covered (follow the
mandate) what is the punishment?  Massachusetts is very light for
example.

* Some of the related by key concepts are:
- need defined cost controls
- need to reduce market variation through transparent data such as
pure profiling
- must focus on evidence-based care
- must create standard medical policies & procedures to reduce variation
- must eliminate firms living off of cost anomalies
- must be aggressive reform on the delivery side (providers)
- must use data and evidence to drive transpancy and help patients seek value
- must show the blue collar family making $70k how transparent data
directly helps them
- must show how this isn't rationing

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