One of the papers at Brookings was an attempt at prognosticating the future of health care costs — for what it’s worth, their best guess was slightly below CBO’s, so it was consistent with CBO’s relatively not-scary long-term fiscal forecasts. But what struck me most was this chart, showing cost growth in different forms of health insurance:

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That flat red line at the bottom is Medicaid.

Everyone who’s serious about the budget realizes that to the extent we do have a long-run fiscal problem — which we do, although it’s far from apocalyptic — it’s mainly about health care costs. And then there’s much wringing of hands about how nobody knows how to control health costs, so maybe we should just give people vouchers, and if they still can’t afford insurance, too bad.

Meanwhile, we have ample evidence that we do know how to control health costs. Every other advanced country does it better than we do — and Medicaid does it far better than private insurance, and better than Medicare too. It does it by being willing to say no, which lets it extract lower prices and refuse some low-payoff medical procedures.

Ah, but you say, Medicaid patients have trouble finding doctors who’ll take them. Yes, sometimes, although it’s a greatly exaggerated issue. Also, middle-class patients would surely be unhappy if transferred from the open-handedness of Medicare to the penny-pinching of Medicaid.

But the problems of access, such as they are, would largely go away if most of the health insurance system were run like Medicaid, since doctors wouldn’t have so many patients able and willing to pay more. And as for complaints about reduced choice, let’s think about this for a moment. First you say that our health cost problems are so severe that we must abandon any notion that Americans are entitled to necessary care, and go over to a voucher system that would leave many Americans out in the cold. Then, informed that we can actually control costs pretty well, while maintaining a universal guarantee, by slightly reducing choice and convenience, you declare this an unconscionable horror.

So, I’m not proposing that we turn the whole system into Medicaid any time soon. But what I take from the data is that if and when we feel the need to make tough choices — really, really make tough choices, not use the rhetoric of tough choices to justify what conservatives wanted to do in any case, namely privatize everything in sight — health cost control won’t turn out to be that hard after all.