David Brooks abandons the false choice

If David Brooks is not the first major pundit/journalist/columnist to abandon the false choice that the candidates and their surrogates are offering on Medicare, he’s the first I’ve noticed to do so. Here he is in his most recent column, channeling his fantasy-Romney’s opening to tomorrow night’s debate:

Nobody knows how to reduce health care inflation. There are two basic approaches, and we probably have to try both simultaneously.

The first, included in Obamacare, is to have an Independent Payment Advisory Board find efficiencies and impose price controls. The problem is that that leaves the painful cost-cutting decisions in Washington, where Congress rules. Congress wrote provisions in the health care law that have already gutted the power of the advisory board. The current law allows Congress to make “cuts” on paper and then undo them with subsequent legislation. That’s what Congress always does.

The second approach, favored by me, is to scrap the perverse fee-for-service incentives and use a more market-based approach. I think there’s ample evidence that this could work, but, to be honest, some serious health economists disagree.

Now, I am not at all claiming Brooks gets everything right here. I can see several problems, and you can go read Sarah Kliff’s post and Jon Cohn’s tweets for their perspectives. My point is that this is the closest thing I’ve seen to anybody with a readership larger than, say, 6,000 people (ahem, that’d be me), recognize that we can run the ACA reforms (the IPAB and other changes to FFS Medicare) alongside premium support (which is what I think Brooks means by “a more market-based approach”).

I’ve been making this point for a long time. See this post or that one.

(Ed note – Austin forgets, but there was a column at CNN advocating that “in a rational world, we’d try all these things”. That column was even picked up by USA Today. I agree I’m not a pundit at David Brooks’ level, but I’m taking credit for this, too! – @aaronecarroll)


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