The Senate Finance Committee has completed the markup of its reform bill, and it will shortly be brought before the committee for a vote. It will then go before the full Senate for debate, likely to be a protracted process. At a moment when everything is still in flux, it might do well to step back and ask what would be a reasonable set of benchmarks for judging congressional efforts to slow annual cost escalation a success. What are some standards for judging that effort as serious and likely to be effective? Here are my priority benchmarks:

Comparative effectiveness research with teeth. No sooner had President Obama’s stimulus package been announced some months ago then its provision of $1.1 billion for comparative effectiveness research was immediately defanged. The Senate Finance Committee said in early statements that the research results could not be used to create treatment guidelines or even to make recommendations, and that limitation was repeated in early drafts of its bill.

That kind of censorship makes no sense, reflecting some physician and many industry interests at work. But physicians need science-based evidence, and some guidelines for its use to practice good medicine. The public, as well as private insurers and government agencies, need good evidence to shape their benefit decisions. Cost-effectiveness research would be even more valuable, but if that is not possible then comparative effectiveness research should be given as much clout as possible.

Management of Competition. If the democrat proposal for mandated insurance coverage makes it through Congress, it will be a windfall for the insurance industry, greatly expanding the number of people it covers. What will be left in place, however, will be the present industry, just expanded. The competition of insurers over the years has never slowed cost escalation, almost always greater than that of Medicare. The Federal Employee Benefit Program (FEHBP) has often been offered as a model employee insurance plan, allowing them to choose among many competing insurance plans. It has been popular but its average annual cost increase has been in the 7 percent to 8 percent, range and often higher. Competition has failed there as well.

The historical lesson is clear: left on its own competition in the private sector in health care will not, as is possible with cell phones and TV screens, control costs. A public choice option, whose fate is in doubt (though House bills still have it in) might make a difference, but then maybe not much. The background costs of American health care, inescapable for both the public and private sectors, will set some firm boundaries to how far they can go to save money.

The idea of a “trigger” should not be put aside. If competition does not stop or decisively slow annual cost increases after a few years, then the government should be empowered to regulate insurer competition, up to and including price controls on premiums. The insurance industry would scream, but far less than a public suffering with a continuation of a 5 to 6 percent annual increase over the next two years.

An independent Medicare advisory commission. The proposal to create an independent Medicare advisory commission– The Medicare Payment and Access Commission – to be located in the Executive branch, is a good one. Congress has had too much control over the program, too often capitulating to political and industry pressures in its oversight and often hampering the work of the Centers for Medicare and Medicaid Service (CMS). Its refusal over the years to allow costs to be taken into account in Medicare coverage decisions has been a serious roadblock to good decision-making. Whether the proposed commission would have the power to remove that obstacle is unclear, but its independence would greatly assist in confronting the cost problems more coherently and comprehensively than Congress has done.

While it would not have authority over the private sector, Medicare’s policies in the past have had considerable sway there and would probably continue to do so. Medicare, on the cusp of a massive influx of baby boomers just as it is also facing imminent insolvency, requires new and more effective leadership, and the proposed Commission might well provide it.

Daniel Callahan is editor of the Health Care Cost Monitor and author of the new book, Taming the Beloved Beast: How Medical Technology Costs are Destroying Our Health Care System.