Health care costs are the biggest obstacle to a sustainable budget, and what our country most needs is a bipartisan way forward to address the inter-connected problems of cost, coverage and quality. This is what I think a bipartisan outcome would look like if the parties actually negotiated:
· Federally guaranteed, universal catastrophic coverage with more insurance available in exchanges. This would render the individual mandate moot
· Modify the tax treatment of employer provided insurance
· End Medicaid by transitioning all dual eligible costs to Medicare, and buying private gap policies for other beneficiaries via exchanges
· Enable Medicare to become an active purchaser of care
· Enact comprehensive medical malpractice reform
· Adopt a cap on overall federal health care spending, with a payroll tax based fail safe that is triggered if specified savings are not achieved
This list includes policy options that I think are clearly warranted along with others that I think are more political in nature. However, that is what we most need, a political solution that provides both “sides” with some credit, but most importantly, gives them both responsibility for moving ahead with the hard work of developing a sustainable health care system.
As an aside, if you hear a politician talking about our need for a long range balanced budget, you should wonder about their health reform plan. If they don't have one, then they have no plan for how our country ever having a balanced budget again. If they have a plan, ask your self if it can get 60 votes in the Senate, 218 in the House and be signed by this or any President. If no, then they don't have a plan, they have a fantasy. The Affordable Care Act has the benefit of being law, and it is the only reform vehicle we have or are likely to have in the near future. It can be tweaked in small or large ways.