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Thinking Big at Brookings

By John Reichard, CQ HealthBeat Editor

August 1, 2007 – Trustees of the Brookings Institution aim to make major changes in the U.S. health care system and insist that a new center they've funded for that purpose won't just hatch big ideas, but will oversee bold action to put those changes in practice. The man they've picked to run the show may seem like an odd choice for a think tank more identified with Democrats and the left than Republicans and the right: former Centers for Medicare and Medicaid Services Administrator Mark B. McClellan.

The center, named the Engelberg Center for Health Care Reform after Brookings trustee Alfred B. Engelberg, "is one of the timeliest and most ambitious ventures we have ever undertaken at Brookings," said Strobe Talbott, the institution's president. Engelberg, who is funding the center along with fellow trustee Leonard D. Schaeffer, former chairman and CEO of the giant HMO operator Wellpoint Health Networks, said in a Brookings news release last week that he expects the center to make a major contribution to the actual implementation of changes.

"Mark McClellan's proven ability to create and implement important health care reforms, combined with Brookings' long history of thoughtful impact on public policy, has the potential to make a real difference in the steps that are taken to fix our broken health care system," Engelberg said.

McClellan, too, emphasized the importance of going beyond merely offering provocative ideas. "The American public wants action, not just more discussions and more studies," he said. McClellan is identified with revisions in health care that are both much praised, primarily from the right, and much criticized, primarily from the left. He oversaw implementation of the Medicare prescription drug benefit, attacked by Democrats as too confusing because of the profusion of private plans offering the benefit, and praised by Republicans because of the resulting competition they credit with driving premiums below levels Democrats called for in a more government-run system. And McClellan is identified with greater state flexibility in the design of Medicaid programs, which supporters say has allowed the delivery of more efficient care to larger populations, but which critics contend has watered down or denied health care to the needy.

McClellan also held three top health posts in the Bush administration, which Democrats accuse of designing health policies with industry profits in mind at the expense of public protections. Yet during McClellan's time at CMS, he was a driving force in promoting policies acknowledged by both political parties and many academics as fundamental to a more efficient system, such as harnessing the power of health information technology and promoting the measurement of quality. And McClellan's career stops include working at the Treasury Department to design prescription drug coverage during the Clinton administration.

His combination of industry contacts, academic credentials, policy experience, and practical experience—he is a practicing internist—could help make the center a focal point of attempts to develop pragmatic public–private solutions involving a broad cross-section of health care organizations.

Schaeffer, also a driving force behind the center, comes out of a similar mold. A health official in the Carter administration and a highly successful HMO executive, Schaeffer told the academic journal Health Affairs in a 2001 interview, "I'm a believer in government. I worked in government, and I think there's an important role for government, but this issue is much more complex," he said. Schaeffer said the government should help fund coverage for Americans with incomes below 200 percent of the poverty line, but contended that in many instances, affordable private coverage is available to uninsured people with higher incomes and that business and government should be working harder to tell them about it.

He also has set the bar high for the center. "As the focus on health care reform increases, the center will prove to be a powerful force in shaping health policy," Schaeffer said.

The center "will work closely with a broad range of public and private organizations," according to Brookings. The goal will be to implement policy not only at the national level, but also at the state and local level.

One of the center's first goals is getting better value for the health care dollar by working to "achieve widespread use of consistent and valid quality and cost measures." That information should help patients and doctors make better health care decisions, Brookings said.

Another early focus will be on implementing policies based on research at Dartmouth College showing that areas with lower concentrations of medical resources can deliver care that is less costly and of a higher quality.

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