The doc fix

Jon Chait has a column on the doc fix and he complains about some of the other policy analysts.  I understand that the doc fix is not a net cost of ACA, since we have been doing it anyway, and I understand that the Republicans are being hypocrites on the issue.  But I have a broader question.  Should we be doing the doc fix at current levels?  If I were a supporter of single payer, I would wish to cut the doc fix.  That is, after all, how single payer systems save so much money, compared to the U.S. system.  They use monopsony to lower reimbursement rates and the quality of outcomes does not always suffer much, if at all.

So are the single payer advocates in fact advocating an end or limit to the doc fix?  That is a literal and naive question — I am not pretending I have caught anyone in a contradiction.  Is Krugman here endorsing the doc fix?  I am not sure, but he does call it "necessary."

One might argue "cutting reimbursement rates works only when you can do it to all rates."  Otherwise doctors flock to the privately insured patients and ration the rest.  Maybe so, but Medicare covers a lot of health care in this country and it's hard to see most doctors giving up on covering old people.  Medicare ought to give the government some monopsony levers and even if supply is a constraint, pushing some elderly further back in the queue does not have to be a bad thing, all constraints considered.  Furthermore we are often told that cutting reimbursement rates will work when it comes to pharmaceuticals, so why not doctors?

Why don't I hear more about this issue?  I would consider joining a liberaltarian alliance to lower the doc fix.  Is there one to be had?

Addendum: Here is Levin's response to Chait.


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