So the NY Times Has gathered a fine group of oxymorons - that would be Republican thinkers - on its editorial page to discussion future biPartisan steps to health reform.

Mark McClellen, now at Brookings does not want to see the whole thing financed by bad taxes - increases in income and payroll taxes - but would be O.K. with an excise tax on employer provided health insurance. Which tax has "been proven to reduce health care costs" by forcing employers to adopt plans that cover nothing which then lead people to avoid medical care. This is a moderate stance when compared to Charles Kolb who says:

Congress should also end the current tax exemption for employer-sponsored insurance coverage. This change would encourage people to pay more attention to the price of their health insurance. And it would provide the money that will be needed to help underwrite coverage for the uninsured.

Again, not a huge departure from the worst features of the current bill.

In addition to this Mark McClellen would like to see insurance exchanges. Um. weren't these part of the bill that all of the Republicans hated? Weren't they also part of the dread Hillarycare? But these would be different because they probably would not impose serious regulations and companies could offer us whatever they wanted to. We would all get mail from the government telling us that we should carefully read the fine print on our health plans. Maybe we would even get nifty tee shirts that said "Caveat Emptor".

In addition McClellen, and others want Medicare to gather more data on quality and outcomes and they would like to see some system of risk adjustment where the government paid health insurers subsidies to take on people with health problems. No ballooning Federal Bureaucracy here folks.

Bill Frist - heart transplant surgeon - wants to pay teams of Doctors, Nurses and so on for outcomes:

This is not rocket science. You simply need to pay people to do a good job, demand measurable outcomes and adopt proven standards of practice and information technology. Reward value, not volume.

Medicare and private insurance companies should reimburse providers not for each discrete service they provide but for managing a patient’s condition over an entire episode of care. In my own field, transplantation, for example, a payer should not separately reimburse 56 different nurses, doctors, pharmacies, imaging centers and hospitals. Instead, it should pay a heart transplant team a fixed sum (adjusted for risk) based on the diagnosis of “heart failure requiring transplantation.” The disbursement of that payment would then be made at the local level, where value can be most accurately determined, and waste most likely eliminated.

This wonderful payment system would be well administered by the accountants and actuaries in the insurance companies and the government. We know this to be a fact since we have seen how well they performed before in the glorious experiment with insurance company managed health care.

To round out the analysis, Newt Gingrich wants us regulate malpractice lawsuits - one imagines we need a system like California's which restricts pain and suffering awards and does not a lot of good. James Pinkerton represents the aluminum foil deflector beanie set with a call for more and better health for everyone without gummit interference and, presumably, without cost to the general public.

Which all pretty much leaves us right where we are now. Little or no regulation of health insurers who steadily increase the prices that they charge individuals and businesses. A continuing erosion of the coverage actually offered through steadily increasing deductibles and other out of pocket charges as well as limits on payments for each illness and accident.

This will all lead to more medical bankruptcies and unreimbursed care as consumers find that they cannot pay their deductibles. Fewer individuals will be covered as the young and healthy are allowed to exempt themselves from paying for the old and unattractive. Rates will continue to rise.

And, despite the pious noises that are made against fee for service medicine, the billing and coding industry will need to remain intact to make sure that we measure how much sick people use the health care system and punish them appropriately for their decision to get old and sick.

On the plus side, it is highly probable that the law can be written so that the new insurance exchanges will be controlled by biPartisan boards which will create new employment opportunities for Republican health economists and unemployed Republican politicians. Risk adjustment payments will provide a new source of income for suffering health insurers and the various studies and research projects proposed will provide years of income for the health economists at Brookings.

We all win, except for the we part.