This is a nice, succinct analysis from the Commonwealth Fund that places health reform into a deficit reduction context and that argues that all parts of the health care system need to have 'the cost curve bent' and not just federal health care spending.
I am increasingly convinced that the hardest part of health reform and bending the cost curve is not technical, but cultural. By that, I mean that people say that they want to slow health care cost inflation, but they don't seem to understand that if that happens, it will mean that we somehow spend less on health care than what we are now projected to spend. You can only cut payment rates so much. Eventually, if we slow health care cost inflation, it will mean that care that could be provided, is not. For example, a surgery that doesn't extend life, or improve quality of life, doesn't take place, when it could have. I think it can be done in a way that helps patients and doesn't harm them, but it will be hard. And we won't know unless we actually try.
Whether you think that some sort of expert-based rationing of care via guidelines and federal boards is the way to go about this, or believe that privatizing Medicare and having competition drive down costs (and everything in between) is the best route to take in bending the curve....the last step if health care cost inflation does slow is that less care will be provided than would be provided under the status quo.
I think we need that. Most say they want want it, but I am not sure I believe them.