My friend Phillip Longman has for three decades been one of America's most creative, common-sensical, and non-doctrinaire thinkers on public policy. His latest piece (in the Washington Monthly) is the best proposal I've ever seen for how to get Medicare spending under control without making seniors pay 68 percent of their medical bills out of pocket (as the Congressional Budget Office says Rep. Paul Ryan's voucher proposal would) or creating a shortage of doctors willing to treat Medicare patients (as Democratic proposals to cut reimbursement to providers might). Longman would require that Medicare stop reimbursing fee-for-service medicine and instead provide benefits exclusively through nonprofit Health Maintenance Organizations and the Veterans Administration. HMOs, Longman points out, worked pretty well until for-profit companies moved in (a point that my New Republic colleague Jon Cohn also made in his superb 2007 book Sick: The Untold Story of America's Health Care Crisis--And The People Who Pay The Price). Longman would require that any HMO that participated in Medicare pay its doctors only on a salaried basis.
The doctors and the insurance companies will hate this idea. But it's a much better deal for senior citizens than the budget reforms currently contemplated by both parties. And, if successful, it might point the way to controlling health care costs for the nonelderly under Obamacare.