politics
economics

Medicare for All Just Isn’t Going to Happen

Boston University, New York Times
Washington Post
Genesis
Response
Penultimate
Finale

Megan McArdle

Washington Post

August 29th, 2019
The clever way to avoid surprise billing without resorting to the sort of price controls you envision is probably to mandate that contracts be handled at the ER level, not at the level of the individual physician or practice, and that anyone who agrees to work in the ER gets reimbursed under the insurer's contract with the ER. It's essentially a tweak to EMTALA, and while hospitals won't like it, they'd probably rather give up surprise billing than accept a government-mandated price ceiling on all their services. It won't solve the problem of rogue surgical anesthesiologists, but it would take care of most of the problem at modest regulatory cost.
But we should step back and observe something: we started at "Medicare for All", and we've ended up discussing whether even one state might possibly implement something that could sort of be called a public option, at some point during the next 20 years.
You and I do not agree on a lot about how the health care system should work. We were on opposite sides of the Obamacare debates. But we seem to agree that ambitious health care reforms are DOA for the foreseeable future.
I'm reminded of that old saw that "The optimist declares 'we live in the best of all possible worlds', and the pessimist says 'you're right!'." I wonder if that is not where we now are.
During the contentious process of health care reform, I had many criticisms of Obamacare's proposed structure. Often (privately, at least) people would concede I had a small point, and then say "But this is the best we can do", and fair enough.
Increasingly, those people seem to be vindicated: Obamacare is the best America can do. It doesn't work like the systems it was modeled on, is extremely expensive, and left us with a large uninsured population. But neither you nor I seem to think we can do better. Or even worse.
I can't say I'm sorry that Medicare for All won't become the law of the land. But I'm not sure that utter stasis is preferable, and that, I fear, is what we will get instead.
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