Facts matter: Sign up for the free Mother Jones Daily newsletter. Support our nonprofit reporting. Subscribe to our print magazine.

Tyler Cowen has a list of 11 healthcare reform ideas (plus three extras) over at his site today, and he says he would “trade away the Obama bill for these in a heart beat.”  I wouldn’t, for reasons having more to do with future reform than with anything on the table today, but there’s plenty to agree on here.  Tyler would like to federalize Medicaid, spend more on medical R&D, make an “all-out” effort to limit hospital infections, encourage the spread of walk-in clinics, and a few other things that I’ve written in favor of before.  So bring ’em on.

But he’s also in favor of limiting universal coverage to catastrophic care, which I’m not so keen on, and thinks that universal coverage is pretty much impossible if you try to build it on top of our current jury-rigged system:

11. Realize that you cannot tack “universal coverage” (which by the way it isn’t) onto the current sprawling mess of a system, so look for all other means of saving lives in other, more cost-effective ways.  If you wish, as a kind of default position, opt for universal coverage if the elderly agree to give up Medicare, moving us to a version of the Swiss system and a truly unified method of coverage.  But don’t bet on that ever happening.

I’m sympathetic to this idea, but I’m not really sure why it has to be true.  The current bills pretty clearly move us along the path toward a Swiss system — not my first choice for a model to follow, but certainly better than what we have now — and I don’t think that the existence of Medicare as a separate part of that really stands in the way.  A single comprehensive system for all would probably be better and more efficient, but it’s hardly an absolute precondition.  My own guess is that a decade or two from now we’ll basically have Medicare for the elderly and the Swiss system for everyone else.  Austin Frakt adds this:

The current debate over health reform is just the beginning–call it Health Reform Debate 1.0 (beta). Debate 2.0 will be about costs, specifically about payment reform….Therefore, I’d like to add a 15th item to Cowen’s list: payment reform that compensates providers, at least in part, on the basis of quality and cost control. That’s very vague. One can conjure up some specifics and some have. Few are thoroughly tested and none have been anywhere near the center of political debate. But they will, and soon.

Agreed.  Coverage first, cost controls second.  It would be great to do it all at once, but politically there’s really no alternative to the way we’re doing now.

REAL QUICK, REAL URGENT

Minority rule, corruption, disinformation, attacks on those who dare tell the truth: There is a direct line from what's happening in Russia and Ukraine to what's happening here at home. And that's what MoJo's Monika Bauerlein writes about in "Their Fight Is Our Fight" to unpack the information war we find ourselves in and share a few examples to show why the power of independent, reader-supported journalism is such a threat to authoritarians.

Corrupt leaders the world over can (and will) try to shut down the truth, but when the truth has millions of people on its side, you can't keep it down for good. And there's no more powerful or urgent argument for your support of Mother Jones' journalism right now than that. We need to raise about $450,000 to hit our online fundraising budget in these next few months, so please read more from Monika and pitch in if you can.

payment methods

REAL QUICK, REAL URGENT

Minority rule, corruption, disinformation, attacks on those who dare tell the truth: There is a direct line from what's happening in Russia and Ukraine to what's happening here at home. And that's what MoJo's Monika Bauerlein writes about in "Their Fight Is Our Fight" to unpack the information war we find ourselves in and share a few examples to show why the power of independent, reader-supported journalism is such a threat to authoritarians.

Corrupt leaders the world over can (and will) try to shut down the truth, but when the truth has millions of people on its side, you can't keep it down for good. And there's no more powerful or urgent argument for your support of Mother Jones' journalism right now than that. We need to raise about $450,000 to hit our online fundraising budget in these next few months, so please read more from Monika and pitch in if you can.

payment methods

We Recommend

Latest

Sign up for our free newsletter

Subscribe to the Mother Jones Daily to have our top stories delivered directly to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.

Subscribe

Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.

Donate