Health-care: Ezra on Stein's Law

Ezra Klein posted an interesting (if a little wonky) piece in the WaPo today about health-care costs and the choices we face as a nation... here is about half of the post, it's good:

The system is currently biased toward the worst form of cost control: rationing by income. Every year, we contain costs by quietly letting 2 million or so more people fall into the ranks of the uninsured. And why not? It does not require an act of Congress. It does not require a war with a powerful interest group. The same cannot be said for cutting provider payments, implementing comparative effectiveness research, founding a public plan or bargaining with pharmaceutical companies. And so the system, which prefers to avoid conflict, prefers letting people lose their coverage to changing how providers practice medicine, because letting people lose their coverage does not require conflict. It's government. As Tom Geoghegan has said, it likes the quiet life.

In a Stein's Law world, we admit that the day of reckoning is imminent. The question is how we'd like it to look. And I'd prefer that the system not be quietly biased toward saving money on the backs of individual people as opposed to providers. Our incentives have gotten a bit insane when you need 60 votes in the Senate to let Medicare bargain down prescription drug prices but no one ever needs to approve a 10 million rise in the ranks of the uninsured. If we agree that hard choices are imminent, we should also be able to agree that there's a utility in setting up incentives for Congress to make them well.