A simple deal

I think that a political deal on health reform is a stepping stone to an overall deal that might allow us to do more in the short run on the economy, while moving toward a long range plan for a sustainable budget.

What about this simple deal as a start. We move ahead to implement the exchanges in the ACA to sell private insurance with income based subsidies. For any state setting up an insurance exchange, we begin competitive bidding in Medicare (with traditional Medicare remaining as an option), two years after the exchange is up and running for persons who are under age 65. This allows states to use the experience from ACA exchanges to inform the changes in the private insurance options in Medicare. And early adopter states can inform those coming along later. The ACA provides states a great deal of flexibility, including catastrophic insurance options.

The details of any deal are obviously important, but the key is that at some point both sides have got to own responsibility for the hard work of addressing health care costs while improving quality and expanding coverage. This won’t happen before the election of course; I just hope that the territory over which the inevitable deal will need to be cut is not scorched too much.