There’s very few mainstream pundits who rise above the din of the Beltway idiocracy. For me, the list was Paul Krugman, Tom Edsall, and Ron Brownstein. Now it includes Ezra Klein:
If Americans felt the full burden of health-care costs, they’d likely be clamoring for all these policies, and maybe more. They’d want transformational change. But they don’t feel those costs, and so they’re resistant to change. Obama continually promises that most Americans will notice no changes in their existing coverage, and all the bills reflect that vow. So what’s left? How do you reform a system you cannot change?
You ask the wonks. People often complain about the length of bills. But you don’t need many pages to explain a public plan, or set up a death panel (kidding!). Rather, the bulk of these bills amount to hundreds of small tweaks and fixes that make this corner of the health-care system a smidge more user-friendly, or that transaction a tad faster. Rather than saving hundreds of billions of dollars with a single dramatic intervention that transforms the system, they provide for the accretion of modest savings and small efficiencies.
For instance, despite all the fire over the co-op plan, it gets two pages in the Finance Committee’s bill. Pages 75 to 110 are all devoted to delivery system changes that are meant to make the system a bit more efficient but that no one has ever heard of. “Value-based purchasing” alone gets six pages in the bill. The “National Pilot Program on Payment Bundling” gets another five.
Melinda Beeuwkes Buntin, a researcher at the Rand Corporation, and David Cutler, a health economist at Harvard, recently estimated the savings that could be attained by “modernizing” the system over the next 10 years. The changes they examined weren’t dramatic. Replacing paper records with computerized files, making it easier for people to comparison-shop across insurers, “bundling” payments for the treatment of a single illness rather than shelling out separately for each doctor visit — that sort of thing. Added up, they equaled a startling $2 trillion over 10 years. That’s a lot of money for policies that have received virtually no attention in the debate.
The whole piece is great. I don’t know whether I’m happy to see something good like this or sad that 99% of what appears in opinion pages on this topic is such bullshit.
