Emanuel, who worked on the president’s health reform effort, makes an excellent point:

The Affordable Care Act requires Medicare to run pilot programs with bundled payments, and recommends expanding the program to the whole country after Jan. 1, 2016, if doing so would reduce costs or improve quality. But why wait? For two decades Medicare has been experimenting with bundled payments. Since 2009, Medicare has been using the Acute Care Episode bundled payment program to cover 37 cardiovascular and orthopedic procedures. While there has not been a definitive evaluation, preliminary data suggest savings of up to 10 percent and improved quality of care. Unfortunately, the program does not cover rehabilitation and other post-discharge services. Worse, it is voluntary and only a few hospitals are participating. To herald the shift away from fee-for-service, Medicare should make the program mandatory for all hospitals beginning Jan. 1, 2013, eliminating fee-for-service for these procedures forever.

One hypothesis is that opponents of bundling recognize that they have another opportunity to defeat it under PPACA. Advocates of the new health law often argue that they needed the “carrot” of coverage expansion to justify the “stick” of system-wide reform, e.g., payment reforms like bundling that would restrain cost growth in Medicare that has traditionally been resisted by incumbent providers. But of course the “stick” is extremely weak and reversible while the “carrot” is a large and significant one that will benefit a vast universe of private insurers, device manufacturers, medical providers, and organized public employees.