Truth and health care

Krugman wrote it. I’ve taken out all the finger pointing. It’s still the truth (maybe more so) without it.

What would a serious approach to our fiscal problems involve? I can summarize it in seven words: health care, health care, health care, revenue. […]

Long-run projections suggest that spending on the major entitlement programs will rise sharply over the decades ahead, but the great bulk of that rise will come from the health insurance programs, not Social Security.

So anyone who is really serious about the budget should be focusing mainly on health care. And by focusing, I don’t mean writing down a number and expecting someone else to make that number happen — a dodge known in the trade as a “magic asterisk.” I mean getting behind specific actions to rein in costs. […]

What would real action on health look like? Well, it might include things like giving an independent commission the power to ensure that Medicare only pays for procedures with real medical value; rewarding health care providers for delivering quality care rather than simply paying a fixed sum for every procedure; limiting the tax deductibility of private insurance plans; and so on.

And what do these things have in common? They’re all in last year’s health reform bill. […]

This brings me to the seventh word of my summary of the real fiscal issues: if you’re serious about the deficit, you should be willing to consider closing at least part of this gap with higher taxes. True, higher taxes aren’t popular, but neither are cuts in government programs.

I know some people will object to the notion that the ACA has cost controls in it. That objection is mostly about whether they will work, whether Congress can be trusted not to undo them. I worry about that too. I also know they’re not enough.

There is a danger of a self-fulfilling prophesy. The cost controls are written into law right now. That’s a fact. By suggesting they are insufficient and anticipating they’ll be weakened are we also telling policymakers to do just that? It’s hard to be cynical and maintain hope. Knowing what we expect, policymakers may deliver it.

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