I hate to give too much faith to administration officials, but it looks like they know exactly what they are doing. The idea is apparently to get people on board with reform by refusing to mess with their incomes that much right now. Of course, the solution advocated by Dean, promising as it is, could mess with those incomes even more, which explains one reason why it wasn't on the table.

I don't really like the fact that the bills don't do more to contain costs, whether it's through something like Dean proposes or through something like bundling, which the article discusses. But at the same time, there's definitely something to the idea that we should pass a bill now and worry about cost controls, whatever they may be, later. After all, how many more shots will we get at this in the next year or two?

I'm actually going to make a prediction: the bill will pass, but the cost controls will be overwhelmed, or rather they will be projected to be less effective than originally thought. Then, as the economy recovers more fully (I'm talking at least three years down the line) and the calls to lower the deficit become louder, they will announce various proposals to reduce it. This strategy of thinking long fits with how the administration tries to act, I think.

I'd tend to agree with Brian J's comment if we had reason to believe that the hard work of reform will be easier later. I see no reason to think that big health care corporations will have less political influence after the government forces everybody to buy insurance, nor that having the medical cost crisis closer will make the irrational opposition any less powerful. And if enough voters find the subsidies insufficient to meet their rising insurance costs, or if unemployment persists at these levels, there will be fewer Democrats and it will be even harder to pass reform than it is now.

I hope I'm wrong, but as one of those monopsony advocates whose role in life appears to be getting arrested or ridiculed by Democratic politicians, I can't help but think that we're about to achieve a Pyrrhic victory.

I would formulate Brian J's thoughts a bit differently.

While Obama may have some influence on the shape of health care reform, his influence is not as great as if he were a GOPper threatening a veto of a health care reform bill. Obama will sign the bill that passes, so the members of Congress will pursue their own agendas. Obama is basically limited to cutting deals with individual members and using the media to influence Congress.

As for our Congress, I'm afraid the fix is in. The members all have specific health care concerns reflected in their constituencies. So, actual reform is not likely.

Reform - at least partial - is coming with or without congress and Obama. One of Cuba's main exports when funded by the Soviets was doctors, and now they have way too many making very little money. Price differentials for even basic tests will make a ferry ride from Miami to Havana economically attractive much less joint replacements, heart bypass, etc. Globalization is going to hit health care providers one way or another. Get your annual physical and a year's supply of medicine while vacationing in the Caribbean.

A while back Apollo healthcare (out of India) was talking about medical cruise ships that could provide procedures with Indian doctors some trained in the USA for low prices.

It Sounded like a great idea to me.

Floccina: I saw a reference to the medical cruise ship idea when I was researching medical tourism a few months ago. While the main "travel agencies" seemed to cater to the wealthy Middle-Easterners for most of their business, some US insurance companies were starting to reimburse for off-shore treatment and large, self-insured companies were also. The Caribbean med schools seemed to be the most popular for US companies while south Asia was popular for Americans paying out of pocket.

If procedure costs continue to rise at current rates in the US, off-shore treatment will be a huge growth business.

I have read the article based on the perfectionists.The idea regarding medical cruise is a great idea to forth in force.I want to know suggestion from others.Costs should be reduced to economic levels to help out the poor people's.

NYT's bias is also shown in its notion of "experts:" the CEO of Mayo, and a doctor-reporter. The CEO knows one aspect of the story in depth, certainly. But he's no Uwe Reinhardt, who has long emphasized concepts like transparency of pricing. Mayo is too paternal for that.

As for the valuable idea of allowing Medicare patients to buy overseas, I wonder if the NYT even has the breadth to understand that. If it could be explained to the SEIU, that might be interesting.

More painful to me, since I'm concerned with the problems of my neighbors in a very poor, crime-ridden city, is how little anyone, whether at the NYT or among the Democrats, seems to care about simple problems like access. Even if the Democrats' plan goes through, my neighbors will still be doing without heat in the winter for the sake of insurance on an overpriced product that they may not be able to get to. And prices will continue to rise. The main difference will be the element of compulsion.

More likely, if price controls drive down docs fees and US citizens decline to become docs, then foreign docs will, one way or another, start working here. They will be very willing to work for lower pay for the advantages to be gained by a dual citizenship in the US.

Medical cruise ships are definitely on the way. They will look something like this:
http://www.the-salvare.com

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