The only way to truly reduce long-term healthcare costs is to slow the creation and adoption of new treatments. That could simply take the form of the FDA slowing down its approval process (which would be almost invisible despite its high cost), or it could mean refusing to give patients on government plans access to new treatments for some time (which would be even less politically acceptable, even though the overall costs to society would be somewhat lower). Naturally you would expect politicians to be exempted from the latter. The third way is essentially the plan on the table; increase government control over the healthcare sector so that profits can be squeezed out of the system and overall innovation drops to a slow trickle. The chief advantage of this approach is that people won't know what new cures and treatments they aren't getting, just like we don't know today what we would have if it weren't for previous attempts to do the same thing.

I can't see how people who are truly sick could be in favor of this plan. This is offering the chronically ill lifetime symptom management in exchange for a decent chance for a cure. Even people who aren't sick yet will likely get some uncured illness in the future; if you are destined to get diabetes in 15 years, for instance, would you rather have a discount on needles and meters or a 25% (I'm being conservative) chance for a cure?

As for your third question, even if the plan didn't get the same protections that employer-based plans enjoy, I think sovereign immunity would still apply.

Mario,

I agree that sovereign-immunity is the ultimate back-boundary here. But I also assume that a government-run insurer would set up some kind of administrative appeals process for denied treatments.

So, as an example, say someone is denied a treatment, appeals the decision, but dies during the appeals process.

Does the government run insurer say...

• The appeal is now moot, because the patient is dead, or
• We need to finish the appeal process, to determine if the patient's family is owed the money for the treatment he or she should have had (this would be parallel to current ERISA law), or
• We need to finish the appeal process, to determine our liability for causing the potentially avoidable death of a patient.

Regardless of whether I would support an effort to perform such a vast re-vamping of the US health care system, I would never support any of the proposals before us now. Not because of their content, but their formation.

Where I work, we habitually design and deploy large systems, which have to interact with other large systems, and which can have significant safety consequences on the people using them. It is de rigour to modularized such systems, testing and validating each segment in isolation, so that any risk to the overall system is minimized. If we ever proposed performing these changes en-mass, we'd be, rightfully, thrown out of the development.

The fact that the health care initiative has not been segmented and presented in inter-operating independent pieces means to me that the people proposing these changes are not smart enough to be allowed to make them.