| There's still a lot of talk out there that the bills that went through the House last night don't really address the cost of health care. I'm still never sure what critics mean when they drive this point. The only two limitations on costs that didn't make it into this bill are (1) Universal budgeting, which was never seriously considered in this Congress (this is a big way of how single-payer and voucher schemes both control costs, by having the entire annual budget approved by Congress), and (2) a public option, which in its serious, cost-cutting-through-monopsony-power mode, was never approved by either chamber.
There's a bunch of other stuff, though, and Ezra walks through the five most proimising. These changes include Medicare programs to reform payment systems away from fee-for-service. If it works, private insurance will be under fairly significant pressure to follow suit, in large part because the transparency under the exchanges will strengthen competition while the regulations will protect consumers from fake insurance.
The only public option that ever scored significant savings was the one tied to Medicare. That one died way back before the full House moved to a vote. It's still a good idea, but it is only one of many.
And the bottom-line is that the bulk of the other ideas to contain costs are in this bill. Comparative effectiveness, MedPAC, capping the subsidies for the employer-based system, payment reform, etc. There's a whole lot of folks who disagree that these will lower costs in the long-term, but they're every bit as proven and sound of ideas as the public option when it comes to long-term cost containment.
Jay and others are probably offended that I'm referring to their criticisms on this front and disregarding research and science. Fine. I'm gonna call that one like I see it. The President didn't fight the House on the excise tax and payment reform because the issues were political winners in the short term. He did it because they're among the most likely ways to actually contain costs in this country.