Over the past year of debate, 10 broad ideas have been offered for bending the health-care cost curve. The Democrats' proposed legislation incorporates virtually every one of them.
Incorporating an idea does not imply that your incorporating a good idea, or that your implementing it well, or that your not adding other factors which increase costs even more.
Form insurance exchanges.
A modest idea at best. In its actually implementation, with all the regulatory control and insurance mandates involved in these exchange, it moves from a modest way to possibly contain costs, to a way to increase costs.
Reduce excessive prices
Either this is a meaningless tautology (we reduce costs by reducing costs), or it means reducing prices without reducing costs, essentially price controls, which are one of the most consistently bad economic ideas that still get significant support. Well this would be a bit different than normal price controls, its having a government set up as a monopsony buyer for a significant segment of the market, and having them arbitrarily decide to pay less, but the effect is much the same as price controls.
Moving to value-based payment in Medicare.
An ill defined idea. Also one that's likely to be modest compared to either the remaining forces pushing costs up, or the additional cost increasing factors that the "reform" effort puts in place.
Tax generous insurance plans.
So taxes, and once again price controls...
Empower an independent Medicare advisory board.
Pay some people to talk about the problem...
Combat Medicare fraud and abuse.
Easy to say, not as easy to do (in fact the effort can add more to costs than it recovers in reduced fraudulent claims). If the government can save money here, than why doesn't it do that first as a way of showing it is capable of containing costs before giving it more responsibility, power, and control.
Note this is essentially what much of the private insurance company overhead amounts to. To the extent that an effort is launched here it will be increasing the overhead costs that seem to bother so many "reform" proponents.
Malpractice reform.
They hardly deserve "full credit" here. Also its not a small adder to costs. And such reform doesn't require 2000 page bills. The effort can be done without this monstrosity passing.
Invest in information technology.
The government has a much worse record of being efficient and productive in this area than the private sector. Look at the FAA's modernization attempts for example. Also this is one more thing that doesn't need a more general reform. To the extent there are some good plans for it, just go ahead and implement those plans. No need for this bill.
Prevention.
Which is not precisely defined, and which is more likely to increase costs than to decrease them. And again you don't need a 2000 page bill that ceases control of the health insurance industry in order to push prevention.
Create a public option.
Because nationalizing other industries has worked so well throughout history... |
