We’ve been making trade-offs in health care reform for a while

I know a few things. The Dude abides. Coffee is beautiful. Kendrick Lamar got robbed at the Grammys. And the internet can never have too much Uwe E. Reinhardt:

Medicare’s sponsors dreamed of a health system in which these blessings would be shared on roughly equal terms by all elderly Americans, regardless of their own ability to pay for needed health care or their race.

To help implement that vision, these proponents reluctantly paid the price the providers of health care extracted in return for accepting the legislation: Congress surrendered to the providers the keys to the United States Treasury, full well knowing that this social contract could have only a short shelf life. One would assume that physicians and hospital leaders knew that as well.

In other words, the proponents of Medicare who signed on to the deal were anything but stupid. When confronted by the health care sector with a harsh trade-off between their cherished vision for health, on the one hand, and a sensible payment policy, on the other, they let their vision override economically sound payment policy. Millions upon millions of America’s senior citizens are indebted to them for a program that remains highly popular to this day.

The history of health care reform in this country can be described as many things, some of which are probably not suitably in front of polite company. But one of those that should be universally understood is that, as a part of our pursuit to generally increase human welfare, we’ve had to make certain trade-offs.

In 1965 that meant accepting a provider payment structure that would guarantee a growing income for physicians and hospitals while escalating the cost for the federal government. We’re dealing with those consequences now, sure, but the millions that Medicare has helped since then is a public policy success story. It’s worth keeping this in mind as we begin to deal with the consequences from compromises that got us the Affordable Care Act. The downsides have elicited the most headlines but there are, so far, four million reasons to think the trade-offs were worth the effort.


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