The Next Health Reform Debate

The initial aspiration of health reform was to simultaneously tackle the issues of cost and access. As the legislative process has done its work, the access aspirations have been trimmed somewhat but the cost aspirations have taken the really big hits. What we have now counts as a better-than-nothing start, but it leaves the basic structure of American medicine the same and the unsustainability of Medicare still in place. As Austin Frakt says:

That’s why the current debate over health reform is just the beginning–call it Health Reform Debate 1.0 (beta). Debate 2.0 will be about costs, specifically about payment reform. [...] payment reform that compensates providers, at least in part, on the basis of quality and cost control. That’s very vague. One can conjure up some specifics and some have. Few are thoroughly tested and none have been anywhere near the center of political debate. But they will, and soon.

Maybe. Another way of looking at it is that Obamacare could make it more feasible to just enact currently unthinkable right-wing schemes to cut Medicare. After all, the main point of the reform legislation in the congress is to be able to say that we now have an individual health insurance market that works—look at all these regulations and affordability credits and whatnot. But the programs being set up for people under the age of 65 are a good deal less generous than the existing program for the 65-and-over crowd. Under the circumstances, I think that would make raising the Medicare eligibility age politically easier than it is now. Not politically easy but politically easier than it is today and potentially politically easier than the substantively superior path of using Medicare to drive reform of the delivery system.