• My first reaction

    My piece at CNN on the Supreme Court decision is out. They decided to title it “A health care victory that’s only a start.” Go read.


    • Thanks to both you and Austin for keeping it real.

      I agree that we still have a long way to go on the issues of access, cost, and what Austin likes to call quality — I prefer to say “effectiveness,” since effectiveness is, IMO, what quality really means and is scalable as opposed to amorphous.

      The next fight coming is with Ryan and his friends over Medicare, a program that obviously needs a big helping of cost control. The question is whether to take Ryan’s approach of giving Medicare enrollees a haircut and asking them to make decisions as to how to spend money that will not meet all their needs, or whether to attack cost from the direction of effectiveness, cutting spending on programs that are wasteful, ineffective, or even harmful, and implementing effective quality assurance to prevent patient injuries.

      Many people object to the notion that this would require decision-making by experts, not ordinary people or their political representatives. This is, in fact, true, in the same sense that other highly technical efforts, from the Manhattan Project to the moon landing to the design of the iPhone were run by experts, not ordinary people or politicians.

      The free bonus here if we do manage to achieve reforms in cost and effectiveness for Medicare is that the past shows us that when Medicare is able to do that kind of thing private insurance is given cover to quickly implement the same reforms.

    • It may be “only a start” but as that old proverb says a journey of a thousand miles begins with a single step.

      As you’ve noted previously, repealling ACA after people have gotten used to the benefits will likely be a politically costly thing to do. I think Romney’s bluster is just that, pre-election bluster. Even if he was elected president I don’t think he could realisticly repeal ACA.