Robert Samuelson comes down on the “fix Medicare first” side of the question:
In the past, scattershot measures have barely affected health spending. What’s needed is a fundamental remaking of the health-care sector — a sweeping “restructuring” — that would overhaul fee-for-service payment and reduce the fragmentation of care.
The place to start would be costly Medicare, the nation’s largest insurance program serving 45 million elderly and disabled. Of course, this would be unpopular, because it would disrupt delivery patterns and reimbursement practices. It’s easier to pretend to be curbing health spending while expanding coverage and spending.
Is there anybody who believes that the healthcare system is just fine as it is? I don’t honestly think so and, worst of all, the path we’re on, as Samuelson documents early in his column, is unsustainable. No reform plan will satisfy everybody. That’s why, although I agree with Samuelson that what is needed is a “sweeping ‘restructuring’”, I’ve long thought that some sort of grand compromise needs to be worked out under which the most closely cherished objectives of each interest group is preserved to the greatest degree possible while the pain that will be inevitable in such a restructuring is shared by all parties.
It doesn’t look to me as though Congress is in a compromise-y sort of mood right now.
