Universal health care, much as we need it, won't happen until there's a change of management in the White House. In the meantime, however, Congress can take an important step toward making our health care system less wasteful, by fixing the Medicare Middleman Multiplication Act of 2003.
What should Congress do? The new Democratic majority is poised to reduce drug prices by allowing -- and, probably, requiring -- Medicare to negotiate prices on behalf of the private drug plans. But it should go further, and force Medicare to offer direct drug coverage that competes on a financially fair basis with the private plans. And it should end the subsidy to Medicare Advantage, forcing H.M.O.'s to engage in fair competition with traditional Medicare.
Conservatives will fight fiercely against these moves. They say they believe in competition -- but they're against competition that might show the public sector doing a better job than the private sector. Progressives should support these moves for the same reason. Ending the subsidies to middlemen, in addition to saving a lot of money, would point the way to broader health care reform.
It seems to me that the calls for a national single payer health care program have been getting much louder the last few weeks, which is good. I agree with Krugman however, and have articulated this before (though perhaps not on this blog). In terms of necessity the time for this is absolutely now, today in a perfect world we should institute national health insurance. However, the institutional standing of our country at this moment does not lend itself to this possibility. Before we can institute such a program, Democrats absolutely have to control the executive branch. If we push too hard, too fast for national health insurance without controlling the executive branch we risk losing the argument at a time when there was never any possibility of passage. Bush cannot hold the veto pen when we pass such a program. That's why I believe Krugman is correct here, ultimately we need national health insurance, but in the meantime we cannot possibly get it signed into law today, so we should chip arround the edges of American health care to make some good positive changes for people that we can get passed into law.