I am not against taxing benefits over a certain level, because I think part of reform should be leveling the playing field, in the sense of the system not having as many clear winners and clear losers. People with really great plans that are primarily funded by employers are enjoying a great deal, and if their deal is made a bit less great in order to make the deal better for the folks who usually slip through the cracks, that’s a pretty defensible compromise in my eyes.

Same thing with caps. Whatever providers and servicers are able to demand really high compensation for certain services are often (though not necessarily) getting a great deal. If that has to be capped to control costs, that’s Ok with me. And I’ll even go ahead and acknowledge that such caps may dampen the motivation for innovation. I think slowing the pace of new advances is probably a plus from the perspective of controlling costs. Currently, the high-cost US system generally finances innovations, and so in a sense subsidizes it for the rest of the world.

In an environment of unlimited demand and limited supply I think it’s obvious that we must ration care. And if we must in some real sense ration care in order to control costs, I would choose to do so by slowing the pace of future innovation than to restrict the availability of current treatments with demonstrable efficacy.

One more component of reform I would like to see is that whatever the new system is, it provided access of each consumer to reasonable choices to control costs themselves by shouldering somewhat more risk. So for example you can choose a higher deductible plan with a lower monthly cost, so you could choose to try to save money presuming health, and then if you got sick it would be more expensive. I thin k the plans where you shoulder say a 10% or 20% cost up to a ceiling where 100% coverage kicks in are a sensible option.