At long last James Capretta, writing at RealClearPolicy, points out the elephant in the health care room:
Opponents of Medicare for All shouldn’t try to defend the dysfunctional status quo. Instead, they should advance reforms that would make the system work better for patients, and bundle them as the alternative to Medicare for All.
The last two years have demonstrated how difficult this challenge will be for Republicans. The GOP failed in its attempt to repeal and replace the Affordable Care Act (ACA) largely because the Trump administration had no clear vision of where it wanted to take the health system, and House and Senate Republicans had too many conflicting objectives to put together a coherent plan. In the end, the GOP fell short on repeal because they couldn’t agree on replace.
That problem persists. A handful of Senate Republicans have been pushing an alternative vision for the health system built on federalism. In its first iteration, this idea was sponsored by Senators Lindsey Graham, Bill Cassidy, and Bill Johnson, as well as former Senator Dean Heller. The Graham-Cassidy-Heller-Johnson plan proposed to convert the new funding for health coverage provided in the ACA into block grants provided to the states. Those funds, combined with a reformed Medicaid program, could be used by the states to provide insurance coverage in ways that differ from the ACA’s framework.
I disagree with his diagnosis of the problem with our system and I disagree that a “functioning market” for health care can be constructed without addressing the supply side. Our problem, as pointed out by Uwe Reinhardt some time ago is it’s the prices, stupid. Unless and until they can find a way to address that the pressure to do something will be irresistible.