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How to Avoid Land Mines

A few days ago in Politico, Carrie Budoff Brown and Chris Frates wrote an article on "Health reform's hidden land mines." It was, in effect, a list of all the ways in which health reform is likely to disappoint the public and/or violate pledges that reform advocates have made over the past two years. Premiums for the majority of Americans might not come down appreciably. Most people couldn't take full advantage of the insurance exchanges, which might include better options and perhaps even a government-run public plan. And so on.

These are all real shortcomings--in some cases, ones experts and writers (myself included) have spent quite a lot of time screaming about. Unfortunately, people frequently react to this sort of news by concluding that health care reform needs to be smaller and more incremental. And that's not exactly a solution to the problem.

You want to speed up the bill, so that people start seeing most of the benefits before 2013? Fine, then allocate an extra few hundred billion dollars to cover the cost. You want to bring down insurane premiums for everybody? Great, all you have to do is push a lot harder on cost control, whether it means more aggressive efforts to drive down the prices of medical goods and services or applying a lot more management and scrutiny to the sort of medical care we actually buy. And so on.

Of course, doing any of these things would mean creating an even bigger health care reform bill--one that spends a lot more money, intervenes in the market a lot more aggressively, and goes to work a lot more quickly. (It's also an argument for a good public plan...) But that seems to be the very opposite of where the conversation seems headed.