The scrum will be an ugly, all-out scramble for dough. You can probably get expanded coverage out of it. You can hammer the hospitals and get much of the $1.2 trillion to pay for the expansion. But you won’t be able to honestly address the toughest issues and still hold your coalition. You won’t get the kind of structural change that will bring down costs long-term. In the scrum, Congress will embrace the easy stuff and bury the hard stuff.
Which is why you have MedPAC. That’s the Medicare Payment Advisory Commission that you want to turn into a health care Federal Reserve Board ”” an aloof technocratic body of experts that will make tough decisions beyond the reach of politics. You can take every thorny issue, throw it to MedPac and consider it solved.
Conservatives will claim you’re giving enormous power to an unelected bunch of wonks. They’ll say that health care is too complicated to be run by experts from Washington. But you’ll say that you are rising above politics. You’ll have your (partial) health care victory. Not bad for a skinny guy with big ears.
The core problem in American health care — and I lived for 20 years under the Canadian system, which is even worse — is this:
People have learnt to expect [b]first-dollar, [i]third-party[/i] coverage[/b]. Only about 10 percent of all health care expenses are paid by the person receiving the services.
Such a disconnect creates perverse incentive structures and utterly distorts market feedback, meaning costs. To substitute ‘government’ for ‘the insurance company’ changes … nothing.
Were I capable of changing the current system I would start with one change, and that only for the first five years — create a [b]regulatory prohibition on all deductibles under $1000[/b]. The now-dominant perverse incentive structure must be removed before any progress is possible.