7.24.2009

David Brooks goes primeval on Health Care

At least, that's what he says. Actually - apart from the irony of advocating "Kill the Rhinos!" when so many conservatives consider Brooks to be a RINO - this is a pretty good column. Brooks points out what few others in the mainstream media have: the current bills do nothing to control costs.

Though I would much prefer a large caliber rifle to a "big heavy hammer," I think he's onto something.
Now that the first wave of legislation is bogging down, you want to take the seeds of cost control and you want to do more. You want to eliminate or cap the tax exemption on employee health benefits. This is a big way to crush one of the core drivers of health care inflation. You’re willing to give MedPAC-style technocrats a chance to take control of Medicare spending away from Congressional spendthrifts.

You want to loosen federal regulations so that states have more room to experiment — not tighten them, as the current legislation does, so that states have less. You want reforms throughout the system that will cut down on first-dollar reimbursement in exchange for catastrophic protection. You want to tie Medicare subsidies to income. You want to look at anything that will move us away from a fee-for-service model, the core perversion in the system.

You want to change incentives at both ends. The legislators who drew up the first bills want to change the provider’s incentives. But big cost savings can also come if consumers have choices and incentives to hunt for cheaper coverage. The Wyden-Bennett bill gives people a chance to choose the best option, instead of imprisoning people in existing coverage, as the current legislation does. The Medicare Part D Reform has produced impressive reductions by allowing consumers to pocket prescription drug savings. Other proposals would give people tax credits and allow them to go to any trusted community group — like AARP or a union or a religious group — that wanted to compete to offer coverage.

Basically, Brooks wants competition, not centralized control. He's absolutely right.