Democrats and Republicans both want to rein in federal spending. To do it, they'd revamp health care in very different ways.
Washington won't stabilize its long-term debt unless it slows rising health care costs, especially for the elderly. That's one conviction that unites President Obama and congressional Republicans.
But the two sides offer divergent paths to that common destination. The differences revolve around three big questions: whether to change the incentives primarily for patients or for health care providers; whether centralized or decentralized action will best drive change; and whether government or individuals should principally bear the brunt and the risk of rising costs. The answers add up to radically different visions of America's social safety net.
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Obama placed his bet with last year's health reform legislation. It aims to slow health care spending mostly by changing the calculus for providers, such as doctors and hospitals. The law advances an integrated strategy to nudge the medical system from today's fee-for-service approach toward a structure that more closely links compensation for providers to results for patients.
For instance, the legislation allows groups of providers to share in savings when they form "accountable care organizations" to better coordinate patient care. It ties hospitals' reimbursements to their quality ratings and penalizes them if too many of their patients must be readmitted. It creates mechanisms, including an independent Medicare board, to incubate further delivery-system changes.