Jon Oberlander has a nice piece in the NEJM discussing the implications of austerity politics on health policy. On the one hand, the need to address deficits could provide impetus to do hard things that might otherwise be impossible. On the other, hard things are hard, and it is much easier to shift costs than it is to actually reduce them (spend less as compared to what would be spent otherwise, on a per capita basis).
The blind spot for both political parties is that whether you believe in market forces or expert driven rationing to slow cost inflation (and everything in between), the last step if we succeed in slowing cost inflation in health care is that someone will get less care and/or someone will be paid less for providing care on a per capita basis, as compared to the default path we are on.
It is hard to imagine doing something this hard without both political parties being involved. And it is nearly impossible to imagine that right now.
