From 'Health Care Reform and Congress'
by Hendrick Hertzberg
The most consequential opposition to the reforms now under consideration is coming from a small group of Blue Dog Democrats, who protest that the plan does too little to control costs. To the extent that their concern is genuine, and not just a reflexive deference to wealth
(they vociferously oppose a modest surtax on the top one per cent, whose effective tax rates have dropped by fifteen per cent since 1979, while their after-tax incomes have more than tripled), they have a point. But it’s a minor point. The prospective reform has more cost-containment provisions than past attempts, and, thanks in part to those same Blue Dogs, it is acquiring more such elements by the day—for example, the proposal for an independent commission able to set Medicare payment rates, which Obama has also embraced.
But the Blue Dogs are playing a dangerous game of chicken. Even if they’re right that reform would do too little about costs, the alternative—which, as the President has repeatedly pointed out, is the status quo—would do nothing. Ultimately, real cost control will require a strong push away from fee-for-service medicine. In Massachusetts, which three years ago enacted its own version of near-universal health insurance, the cost of expanded coverage has created pressure for just such a push. That state’s experience suggests that the cost problem, too, will be easier to solve under a reformed system, with all its other benefits, than under the one we have now.
http://www.newyorker.com/talk/comment/2009/08/03/090803taco_talk_hertzberg