Health economist Victor Fuchs, PhD, has been watching the health-care debate in Washington very carefully. Despite the recent optimism of Congressional Democrats, Fuchs hasn’t wavered from his belief that a system overhaul won’t happen anytime soon - but he does think the prospects for some type of reform are promising. In a Perspective in this week’s issue of the New England Journal of Medicine, he discusses four specific reforms that “should and could be enacted:” the formation of insurance exchanges, the elimination of the tax exemption of employer-based health insurance, the creation of a commission to propose changes to Medicare reimbursements and funding for an “independent institute for technology assessment.” As Fuchs writes:
I believe that the four reforms... have more chance of doing good than harm, will lower rather than increase the deficit, and will reinforce one another. Given the complexity of health care, that's the most we can expect until comprehensive change in the financing and organization of care becomes politically possible.
