June 29, 2012


Modesty and Audacity (DAVID BROOKS, 6/29/12, NY Times)

And here's the biggest gift that Roberts gave to the nation: By restraining the power of the court to shape health care policy, he opened up space for the rest of us to shape that policy through the political process. By modestly refraining from rewriting health care laws himself, he has given voters and politicians more room to be audacious.

The decision doesn't end the health care debate; it accelerates it. I spoke to some conservatives on Thursday. They were disappointed by the ruling, but they were delighted with the language on the commerce clause. Most of all, they were excited about the coming political debate. They remain sure that Obamacare is a fatally unpopular and flawed Rube Goldberg device and were energized to work harder for its repeal.

I spoke to some liberals Thursday, too. It was striking how quickly their comments moved from the past to the future -- to the need to ramp up the exchanges, modernize delivery systems and build on the bundling experiments.

People in both camps seem to agree: We've had a big argument about health care over the past several years, yet we haven't tackled the big issues. We haven't tackled the end-of-life issues. We haven't fixed the medical malpractice system. We are only beginning to correct the antiquated administrative systems.

Crucially, we haven't addressed the structural perversities that are driving the health care system to bankruptcy. Obamacare or no Obamacare, American health care is still distorted by the fee-for-service system that rewards quantity over quality and creates a gigantic incentive for inefficiency and waste. Obamacare or no Obamacare, the system is still distorted by the tax exclusion for employer-provided plans that prevents transparency, hides the relationship between cost and value and encourages overspending.

...is that it is conservatives who need the mandate to bring market forces to bear on such problems, via universal HSAs, which is why it was their idea in the first place--back before they started pretending it was unconstitutional....

Posted by at June 29, 2012 6:41 PM

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