August 17, 2010
The Potholes Ahead for Health Care Reform

A teaser from Yale political scientist Jacob S. Hacker’s terrific summary of what lies ahead for Obama’s health reforms. Read it all here.

No one who has studied the medical market in recent years can fail to recognize the unhealthy consolidation that has taken place. An ironic coda to the public option’s demise was the release this February of the American Medical Association’s latest report on insurance competition. Its verdict? A “near total collapse of competitive and dynamic health insurance markets,” with more than half of metropolitan areas dominated by a single insurer enjoying at least half the market (up from 40 percent of areas in 2008). Of course, what the AMA neglected to mention is that massive consolidation has also taken place on the provider side, with most metropolitan areas dominated by a single hospital or flagship system.

Comparative-effectiveness research, changes in Medicare payments, encouraging greater competition through exchanges, even taxing high-cost health plans — none of this will seriously restrain costs without the creation of countervailing power to pressure consolidated insurers and provider systems to change their prices and practices. And the only place where this power can ultimately come from is the public sector. For better or worse, the ultimate fate of reform hinges on progressives’ efforts to rehabilitate American government…



Posted by Jerome Doolittle at August 17, 2010 12:31 PM
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I fully expect to take it up the yang yang on this.

Posted by: One Fly on August 17, 2010 1:16 PM

Social Security and Medicare are going to be challenged about 10 years from now. We need more revenue coming in and possibly lower taxes is the answer.

Posted by: High Deductible on August 17, 2010 6:52 PM

Social Security is in fine shape for the next 30 years. Reagan raised FICA taxes and increased the standard retirement age, gradually, to 67 for those who are now middle-aged (and considered too old for a new job when they get laid off).

Medicare would have been fine had health care changes gone to a universal, single-payer plan for all Americans. Most people now have crappy health insurance (although most people don't realize how crappy it is until they try to use it for something complex or prolonged) with lots of medical care not covered, big copays, and big deductibles; tens of millions of others don't have any health insurance. I would like to see comparative data on health care usage at age 64 and age 65, because I believe millions of people dump a load of cost on Medicare by putting off put-offable medical care until that magical 65th birthday.

Government needs more revenue coming in, and higher taxes is the answer.

Posted by: Joyful on August 20, 2010 3:59 PM
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