Tyler Dares Obama

In the NYT, Tyler Cowen dares Obama to put up or shut up:

Medicare expenditures threaten to crush the federal budget, yet the Obama administration is proposing that we start by spending more now so we can spend less later. … Obama administration talks of empowering an independent board of experts to judge the comparative effectiveness of health care expenditures …

[Yet] Congress has not been willing to give up its power over what is perhaps the government’s single most important program. … There is already a Medicare Advisory Payment Commission, but it isn’t allowed to actually cut costs. …

If we are willing to take comparative-effectiveness studies seriously, we could make significant cuts in Medicare costs right now. We could cut some reimbursement rates, limit coverage for some of the more speculative treatments, like some forms of knee and back surgery, and place more limits on end-of-life-care. … If we aren’t willing to take even limited steps to conserve resources, we shouldn’t be spending any more money elsewhere. …

67 percent of Americans believe that they do not receive enough treatment … only 16 percent believe that they have received unnecessary care. If the Obama administration covers more people … the political support will broaden for generous benefits.  … Mr. Obama has pledged to be a fiscally responsible president. This is the biggest chance so far to see whether he means it.

Wonks have for years warned of the coming US fiscal “train wreck” of retiring baby boomers riding the medical cost escalator.   Politicians ignored the wonks and even expanded Medicare drug benefits, and then suddenly dug deep to respond to a financial meltdown.  Now Obama proposes to spend even more.   Tyler is right; if they can’t find the nerve to cut costs now, don’t expect them to do so until forced.

(Tyler quotes me, but I’d agree with him here even if he hadn’t.)

Added: Clyde Middleton weighs in.