Friday, December 11, 2009

Medical reform: the continuing saga

Although I would not have expected this, it seems to me that the reform bill now discussed in the Senate is being greatly improved as it goes through the mill. I still have doubts whether passing it would be a good idea, but two of the recent changes are undermining these doubts:

First, the proposal to allow people to buy into Medicare starting at age 55.

Second, allowing people to buy insurance the same way as government employees (including members of Congress), with the same government agency negotiating some standard contracts that would be available from insurance companies throughout the country.

The beauty of these changes lies first of all in their radical reduction in complexity from the previous provisions for a "public" option, an option which never did make much sense to me. Second, they do not require creation of a new government administration system. Third, these steps might indeed be only the first in a series which would ultimately end up with universal coverage in a system that approximates the single-payer provisions in numerous foreign countries.

Supporters of the legislation before these two changes thought that, bad as the bill was, it would be a camel's nose in the tent that would make further reforms easier. I was afraid that the bill might have the opposite effect, helping to freeze the current dysfunctional system in concrete. With these two changes, the camel may be beginning to enter the tent.

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