Two relatively new books that I have not read. One is by Roger Feldman.

Should Medicare pay for patient expenses the way automobile insurers pay for car-repair bills?

…Medicare would pay each patient a fixed amount of money, reserving larger subsidies for sicker people. Patients, in turn, would select their own medical services from providers who would set their own competitive rates. A medical indemnity system would do away with the distortion in patients’ incentives wrought by conventional Medicare coverage. Given a fixed amount of money to spend on medical care, patients would have strong incentives to shop for the combination of services, providers, and prices that most closely meet their needs.

The other is by Mark Pauly.

There is no magic that can preserve Medicare as we know it today…a voucher system could provide full coverage for the poor, ensure that all seniors have access to a minimum level of coverage, and empower consumers to make decisions about their health care. Converting Medicare to vouchers would create a neutral Medicare market, set realistic limits on the growth in spending, promote efficiency, and give seniors the freedom to choose the plan most suitable for them at the quality level they prefer.

The conventional wisdom is that the Democrats “own” the health care issue. Unfortunately, they are the party most committed to the existing system and most resistant to reform, particularly when it comes to Medicare. The Democrats are under the impression that all of the excess costs in the system are profits, and if we just get rid of those, we will be fine.

The meaningful reform proposals come from folks like Feldman or Pauly or Kling. We have no standing with Republicans (at least I don’t), much less the Democrats who appear to be headed toward dominance over the next few years. I predict that we will have no meaningful health care reform in the foreseeable future.