Paul Starr with a useful suggestion about an individual mandate....modify it and let people opt-out of the mandate, but in doing so, they forgeit their right to federal subsidies such as Medicaid for 5 years. I would go one step further, and say they lose right to Medicaid and also waive their rights to be treated under the IMTALA laws that mandate that uninsured persons be treated in emergency rooms if that facility treats Medicare and Medicaid beneficiaries (ie all of them). If persons opted out of the mandate, they could apply for insurance but insurers could underwrite and exclude them based on their health. This is a way to both allow people to exercise their freedom as well as to reduce the free rider problem.
An interesting interview with a doctor saying that doctors are not innocent bystanders to the rate of cost inflation and criticizing them for seeming to say lets do reform so long as our income stays the same. His idea of each specialty identifying a 'top 5' procedures that are commonly done that typically don't help patients much but that cost alot is a good idea....and the kind of work I would hope that an Independent Medicare Advisory Commission would undertake. You don't like such expert driven rationing? With Ryan's road map, you really have two choices....expert driven rationing or vouchering of Medicare and letting the market work it out (with the it being rationing). Status quo is bankrupt program. Our we could just jack the payroll tax......but you really have to pick one, or some combination. What this doc is writing is sort of what I had in mind when I wrote this in terms of 'docs leading the way.'