Krugman: Choices Must Be Made

[ProSense]

Choices Must Be Made

Arguably the most important thing we can do to limit the growth in health care costs is learning to say no; we cannot afford a system in which Medicare in particular will pay for anything, especially when that’s combined with an industry structure that gives providers a strong financial incentive to engage in excessive care.

So naturally, the Independent Payment Advisory Board, which is the first step toward making rational choices, is under attack.

Mainly the attack is coming from Republicans, who want to dismantle Medicare, not save it — their proposal is that instead of having Medicare make choices based on expert advice, we should give seniors inadequate vouchers and let insurance company executives make those choices instead.

But there are some Democrats in opposition too. Some really want Congress to make these decisions — although you really have to wonder how they can believe that’s realistic. Others, as Jonathan Cohn notes, have suspiciously close ties to industry groups that benefit from the system’s current inefficiency.

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[damntexdem]

1. We cannot afford a system in which Medicare will pay anything for anything.

First, reform the remaining idiocies of Part D: allow Medicare (and while at it, Medicaid) to negotiate with big pharma on the prices of drugs. That is, allow what is allowed to big providers (e.g., Kaiser) -- use the power of size to counteract the size of big drug companies and demand lower prices for drugs.

Once that's done, then tackle the prices of other healthcare services and products.

Then consider whether some things shouldn't be paid for; but be very careful and restrictive on what might be cut out. And consider whether some additional things should be paid for. Example: the famous "death panels" -- as in earlier Obamacare drafts, pay for consultation with physicians on what a Medicare recipient wants done at the end of life. Paying for that could lead to lower payouts for heroic efforts to prolong life unwanted by those now being subjected to them.