I wonder why there isn’t more emphasis on trying the low hanging fruit first. Like how so much money is spent on the last week of life. Or how ridiculous and time consuming CMS mandates are. Or how the insurance review process works. Or why the government doesn’t just make generic medications. I feel like the system could do much better with some small tweaks that don’t seem that controversial.
wow, so naive. the things you mention are all
extremely controversial and are not small tweaks at all with multiple special interest groups fighting tooth and nail to stop this.
1. whichever you slice it, more money is going to spent in the last week of life then at other time, for good reason. Any talk of rationing (which is essential for healthcare reform) leads to hysteria, cries of death panels, nazism, systematic genocide etc, and the rise of unlikely bedfellows of evangelical conservatives, disability rights activists, for-profit health companies, and catholics banding together. no politician is going near this with a 10 foot bargepole.
2. CMS mandates (presumably MACRA) was the result of almost 20 years of vicious fighting between physicians and the government over repeal of the SGR. without which medicare would have collapsed altogether.
3. insurance reviews exist to cut costs. the only way to alter this process would be to either dismantle health insurance companies altogether or outlaw for-profit insurance companies (most people don't realize that while medicare is "government insurance" it is privately administered by for-profit companies).
4. the government does not make generics because the pharmaceutical industry has fought all its might to prevent any such legislation from being enacted. PhARMA is one of the biggest lobbyists in washington. the ACA deliberately sidestepped the thorny problem of drug-prices because it would never have passed if it did. Obama had to promise
not to negotiate drug prices to get their backing for the ACA. This is not to mention that the idea of the government interfering in industry through public ownership is not only pure-blooded socialism, but as fundamentally unamerican as you can get. many people support government generics and most people agree drug prices are too high. but congress is too entrenched in PhARMA money and socialism is still a dirty word.
so your proposals aren't "small tweaks" but radical, are highly controversial, and it would probably be easier to enact Medicare-for-all than your individual proposals, and I'm not all that confident about the chances for medicare-for-all.