Chanos
In my view these programs are probably be the third rail of politics and the party enacting these reforms (if not done well)could slide in next years Midterms. From my thinking, more than likely they would not want to raise the specter of reform before the election. This is where I think Chanos is misjudging the ability of politicians to forestall tough decisions. That said, I see Ryan as being ill equipped to try to cut costs since his cohorts have previously bristled about "death panels" when Obamacare was first proposed. So it's hard to see Republicans moving toward greater government decision making (like Britain's NICE).
If health care is not allocated on a cost benefit approach, I'm not sure the program reform can be successful. My fear is that reform will start with a savings number that they want to achieve and they will work backwards by slashing portions of the program budgets and kicking costs back to the states. Ultimately, a change in the paradigm is required. NVS' approach of payment for Entresto and CarT treatment when benefits are demonstrated is an example of something that should become more widespread. Genomic testing which focuses on treatment and avoiding treatments unlikely to provide benefit is another area where I believe the cost benefit analysis is helpful. It will take a tipping point for some of these points to gain traction. It appears that Biosimilars are finally reaching this point and future cost savings should be realized as a result. Similar progress will need to be made in other cost saving areas.
Medicare and Medicaid not paying for ineffective drugs could result in a "Health Care Winter", but I don't think the current climate of non- government intervention will result in this anytime soon.
FL
