In the interest of “common ground,” we could see a proposal like increasing cost sharing in Medicare. It would be astounding for Democrats to do so, coming off of a successful effort to blame Republicans for… increasing cost sharing in Medicare, by ending the program and giving seniors a too-small coupon to purchase health insurance.

Large segments of the system no longer function within a competitive market framework, if they ever did. When you see the system in terms of quasi-utilities providing necessary public services in a non-competitive framework, then relying on something like an IPAB, and not Congress, makes sense. And the only way the IPAB can do a decent job is to recognized what paradigm it’s in.