Ask yourself, what do we have to do to control Medicare costs? We can save some money, maybe a lot, by reforming payment systems so that providers are paid for overall treatment rather than on a fee-for-service basis. But over the long term, the fundamental issue is going to be to decide what Medicare will and won’t pay for. We need, as Henry Aaron has often said, to learn how to say no.
Notice that this is very different from the issue on Social Security. You can propose simply cutting retirement benefits by 25 percent,and that’s doable. But you can’t decide to do only three-quarters of every operation and test that Medicare pays for (and no, you can’t demand that patients pay 1/4 of the cost without effectively denying care to many Americans.) So Medicare cuts are an inherently harder problem than SS cuts. In fact, I suspect that’s one reason, beyond the political motivations, why inside-the-Beltway types love to talk about Social Security, a trivial concern, while avoiding the vastly more important Medicare issue.
So how are you going to make decisions about what not to do? Um, you need good information about which medical interventions work, and how well they work: comparative effectiveness research. And no, that information isn’t already out there: doctors know surprisingly little about how effective procedures are relative to one another.
Why, then, are Republicans opposed to this kind of research? Some of it is sheer stupidity and/or anti-intellectualism — hey, those researchers are probably atheistic Democrats, you know.
But you should always remember that the GOP comes to bury Medicare, not to save it. The favored “solution” on the right is to replace Medicare with vouchers whose value will systematically lag behind medical costs; so it will be up to insurance companies and patients to say no. There is absolutely no reason to believe that such a system would work; in practice, it would mean denying adequate coverage to all but the affluent. But that’s not a bug, it’s a feature. - Paul Krugman
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