Fire, meet gas

is what David Brooks sees in the Congressional health reform bills winding their way through the various committees. His main point is that the bills are focused only on covering the uninsured, and then in trying to pay for these expansions either through reducing federal spending or raising taxes (they seem to be serious about doing this). But they aren't focused on trying to slow down health spending.

I can follow the logic of saying we have to cover everyone first, get rid of the cross subsidies in the system and then move to slowing down costs. But, that logic seems to apply most strongly to a single payer approach which would have the ability to use cost effectiveness research on a comprehensive basis. And that option is not seriously in play.

The broad cuts to Medicare which are a part of (paying for) all the Congressional plans are very blunt tools, and not an attempt to seriously address situations like this. Cutting Medicare payment rates could actually incentivize providers to undertake the 'higher cost, but maybe not worth it', treatment options.