As efforts to revamp the U.S. healthcare are underway, U.S. Senators leading the effort said they had started the process of examining proposals that were aimed at improving the quality of care. They added that tough decisions of how to cover the uninsured were however being left for later.

Senate Finance Committee Chairman Max Baucus said, "Today we kicked off the process of writing a comprehensive health reform bill." The closed door meeting of panel members focused on proposals aimed at changing the payment system for the Medicare program for the elderly.

Baucus and Senator Charles Grassley said lawmakers were agreeable about the broad goal but had questions about implementation and regional impact. The panel’s focus is on the government Medicare and Medicaid payment structure as it can influence private healthcare providers.

Baucus in a recent session with reporters said, "The key to health care reform is delivery system reform — reimbursing providers on the basis of quality, not volume."

The panel is pushing to draft the health form legislation by June in order to get a final bill to President Barack Obama by the end of the year. The main objective is overhauling the $2.5 trillion U.S. healthcare industry and covering an estimated 46 million uninsured Americans. The main areas that are tricky are the role of government in covering the uninsured and how it will pay.

Bonus payments to doctors and hospitals that deliver better care and keep their patients out of hospitals, better compensation for primary care doctors who oversee patient care and walk them through any treatments or procedures are some of the considerations being considered by panel members. 

They also hope to review policy options aimed at making medical providers more accountable for the quality of care. Changes are also in the pipeline for private insurance plans that serve seniors on Medicare, as well as nursing homes, home health agencies and other providers.

The idea of a public plan that would compete with private insurers is backed by many Democrats including Obama and sixteen members of the Senate Democratic caucus on Wednesday wrote a letter in support of a public plan to Baucus and Senator Edward Kennedy.

Senator John Rockefeller, one of the senators signing the letter said, "We need to provide quality, affordable coverage for the millions of Americans the insurance industry has failed and a public plan is the only reliable way to do just that.”

However Republicans and insurance companies oppose creation of a new public plan as they feel many people would pull out of their current policies and sign up for the government plan thereby affecting the private players.