Health Care Reform: Trying to Think

Remember those essays on the SAT exam that you had to read and then answer questions about? Well this is why:

http://www.brookings.edu/

I got the link from a very good David Brooks column on health care reform (that also talks about the Goldhill article I mentioned), and I read "Bending the Curve." It's easy to understand why many people would prefer to deal in slogans rather than information because the bureacratese combines with one's own imagination to make one feel strange-lovey.

The general ideas set out in "Bending the Curve" are
a) restructure reimbursements--especially in the public sector;
b) link outcomes to provider reimbursement;
c) some form of tort reform; and
d) somehow reward improvements in health by individual and *community* incentives.

On a) and b), couldn't some reforms be done through policy changes in Medicare and Medicaid? Do improvements in IT and reimbursement policies really require an act of Congress?

On b) and c), the proposals involve adding more committees and bureaucracy, boards and oversight. I have no idea how an Accountable Care Organization would work in the real Medicare system. And couldn't quite figure out what a "CMS" really is, never mind how to streamline and expand it at the same time.

On d) it seems I might get a refund if I lose weight. But what if I gain! Will national annual weigh-ins be mandated? Who will turn me in if I take up smoking? On the *community* incentives, will cameras in school record corn syrup intake?

Reader, you know I'm a liberal but I can see how the right wing gets set off by stuff like this.