James Capretta of the Ethics and Public Policy Center argues that we should not try to reform healthcare by merely tweaking Medicare, but rather we should let the market lead and allow Medicare to follow. Medicare, Capretta observes, is the dominant payer in American healthcare. It is the payer around which the rest of the healthcare industry organizes its business, yet it is fragmented, wasteful, and lacks coordination. Although there are efforts underway to move Medicare away from a fee-for-service model, which rewards volume, the fundamental question, according to Capretta, is what can be done to bring about continuous productivity increase in healthcare. Only a free market mechanism, not the government, says Capretta, can bring about such a change.
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