The Unanswered Question on Containing Costs: Is This Time REALLY Different?

CMS Administrator Berwick appeared on C-SPAN’s Newsmakers program over the weekend (video available here), and the program included a very key exchange regarding the ability of government to improve health care costs and quality.  The Los Angeles Times’ Noam Levey noted that more than 45 years after its creation, Medicare costs still continue to rise unabated, and care is as fragmented as it’s always been.  He asked Dr. Berwick: “Why should the public when it hears you, when it hears the President say, ‘Don’t worry – this time we’re going to make it better, we’re going to give you a more efficient, higher-quality health care system,’ why should they believe that the federal government can do now what it essentially hasn’t really been able to do for close to half a century?”

Dr. Berwick didn’t answer the question – in fact, his response raised more questions than it answered.  He said that the problems of higher costs and fragmented care “are not Medicare problems – they’re health care system problems.”  But isn’t the entire premise of Democrats’ health reform centered on the belief that Medicare should be a model for our health care system?  If so, why did Dr. Berwick attempt to fob Medicare’s problems off on the health care system generally – as a model for the entire health system, shouldn’t Medicare be responsible for systemic flaws in our current methods of care?

Therein lie the questions that Democrats haven’t answered regarding their controversial health care law.  If the law’s supporters intend for Medicare to drive the health care innovations of the future, then that by definition means Medicare is the root cause of our current health system difficulties.  It therefore also means that Democrats need to explain why government, having caused many of the structural problems plaguing our health care system, can now create a solution in a way it has not for nearly 50 years.

Our nation is currently recovering from a housing and financial crisis sparked in part by the herd mentality that suggested “this time is different” when it came to constantly rising house prices.  Given Dr. Berwick’s comments this weekend, many may wonder whether Democrats have exacerbated our fiscal crisis by failing to explain why this time is different with respect to the ability of government bureaucrats to contain costs (without resorting to arbitrary rationing to do so).