In the Arena

Fixing Medicare, For Real

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I’m a big fan of Matt Miller’s columns and books about domestic public policy. Today, he has a very good column about the real problem with Medicare. Here’s the most important point:

Rightly understood, health-care entitlement reform is not, as conservatives suggest, a matter of lessening the dependency of big chunks of the population on government largesse. It’s about weaning the members of our medical-industrial complex from their entitlement to far higher payments, despite shabby results, than their counterparts abroad get. This license for inefficiency, issued by both parties to doctors, hospitals, health plans, drugmakers and device firms, is diverting precious resources in an aging America from urgent non-health care, non-elderly needs.

Matt promises future columns about how to get that done–and I won’t be surprised if this involves replacing fee-for-service medicine with salaries for doctors and a heavy reliance on electronic record-keeping and best practices that I described in my piece about the death of my parents. Atul Gawande, who has done some of the very best writing about our medical system, makes a similar point in his recent New Yorker piece comparing the way the Cheesecake Factory works to the current chaos of our medical system.

The real frustration for me here, as with so many other issues we face today, is that there are good answers out there–but they are unattainable because of political gridlock and the entrenched powers that special interests have in a mature democracy. In his Time magazine interview this week, Mitt Romney talked about the inability of government to react to change as well as private enterprise does. True enough. There’s no creative destruction in government–but there’s also tremendous amounts of money staked on the status quo. We need to address both, but I’m not very optimistic that we will.