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  1. Jason is of course right, although one could argue that fiscal conservatism had a slight comeback in the 1992-1999 period. Certainly hasnt been around much in the 1956-2006 period.
    But at some point the rest of the economy cannot support all of its surplus going to health care. Whether that’s 20% of GDP, 30%, 40%, 50% I dont know! But whenever that point is, then the open spigot to the system will end

  2. holt’s mistake in that article is that he assumes that “budget conservatives” make policy decisions in Washington.
    I dont know what country you live in, but we havent had any “budget conservatives” in power for at least 30 years.
    Fiscal conservatism is dead and its not coming back. Neither the republicans nor the democrats consider fiscal conservatism to be a major policy mover.

  3. An excellent piece Matthew. Two statements really stand out for me:
    1.> “We pay specialists far too much for their time, and generalists too little.” I would add we pay physicians too much for their technical skills and not nearly enough for their cognitive skills.
    2.> “in a rational world we shouldn’t have Medicare paying fixed fees to physicians and hospitals without being able to control the volume of services or the total cost.” Fundamentally the incentives and structure of who pays for health services versus who receives them is screwed up beyond belief. That’s why most efforts based on the traditional “marketplace” simply do not work in healthcare. It does appear that HDHP’s are having some impact – in that hospital admission rates appear to be down across the board. One could only wish for better ways to make decisions in healthcare besides cost.
    There is plenty of money in the “system”. It is simply too fragmented. In all the talk about healthcare costs, I seldom see anyone recognize that if you flip it around, there is a tremendous amount of money being made, with very little incentive on the part of those receiving it to act any different than they do now.

  4. Are there entrepreneurs/private equity funds/academics “out there,” who are interested in/working on providing, (for a profit, hopefully) objective quality cost data on H/C providers so that consumers enrolled in CDHP’s have the information needed to make rational choices in H/C spending?

  5. Perhaps CMS (and taxpayers) would be better served if CMS did more to promote pricing transparency by, for example, posting the reimbursement rates for all DRG codes by hospital and zip code on its website.
    Maybe establishing an unbiased objective infomediary within CMS and/or providng seed capital to launch others might be useful.
    It could also promote living wills and advance directives which could reduce healthcare utilization at the end of life in cases where the prognosis is futile.
    Just because CMS can’t seem to win the reimbursement battles against the K Street lobbyists doesn’t mean there aren’t other strategies available to attack escalating costs. Why not try some?