As the country has struggled to raise the debt ceiling, there have been periodic expectations that the current fiscal distress would produce the "right environment" to finally reform entitlements -- particularly Medicare. This has seemed quite astounding to me, 15 months before a presidential election year, given the presence of a divided Congress and our highly charged political environment.
At the end of November, the most recent "doc fix" will expires. Without congressional action, physicians who see Medicare patients will face an across-the-board 23% reduction in their fees. If nothing happens by January, physicians would face an additional 7 percent reduction.
Incremental proposals would make health care reform more complicated — many of the pieces of the current reform bills are interrelated - but they can provide significant and sustainable changes in the right direction.
As we move to the endgame of what will at best be health care reform 1.0, it is also important to remember that if we want to improve health—presumably health care reform is a means to improving health—we need to focus on more than just health care and reform of the health care system.