Payment Reform — The Need to Harmonize Approaches in Medicare and the Private Sector

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Abstract
In the midst of heated debate over health care reform, there is an emerging consensus that the way we pay for health care — with our widespread reliance on fee-for-service payment models — is a core problem that must be fixed. Unfortunately, too many of the policies proposed as part of reform seem to reflect the magical thinking that if we only “change Medicare” then all will be right in the world. Medicare is indeed the largest purchaser of health care in the United States, but at $414 billion out of almost $2.4 trillion, it represents only 19% of total health care spending (see graph ).1 Medicare must help lead the effort to change payment, but if we're going to create a higher-value system overall, we need to change how all public and private payers reimburse for services.

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