Progress on Key Health Care Reform Issues?
I recently posted on what I see as a growing consensus for finding the money for health care reform—albeit only about half of it.
I also see some consensus on what a health care reform structure could look like--or not look like.
Proposals for a public health plan that would compete in the under-age-65 market look to me to be out--particularly one that would pay Medicare rates. I do expect the House to include it in their version of health care reform and for advocates to be forceful in their advocacy in the coming weeks but it has far less support in the Senate where the real deal would be done. Simply, there are too many implications and risks inherent in the idea for not only Republican Senators, but more importantly, moderate Democrats. The biggest being the potential for a public health plan to dominate the market. Proposals to neuter the idea by even advocates lead one to question, “Then why do it in the first place?” [See: A Public Health Plan That Looks Just Like a Big HMO---Why?]
I don't see a consensus in the Senate emerging that includes a public health plan alternative that would have the potential to grab huge market share.
However, there are still a number of other really big undecided health care reform issues:
- Mandates—employer or individual? Still strong opposition to both—particularly from the employer community for an employer mandate out of fear the value of ERISA would be lost in the face of what would be growing benefit mandates. It is possible a partial individual mandate that focused on people with incomes high enough to truly afford coverage, as well as those who are eligible for employer-provided care but not taking it, could emerge.
- Insurance Exchanges and Insurance Underwriting Rules? Even an Obama campaign-like health bill could leave something close to 20 million uninsured (Lewin, October 2008). That means lots of potential for anti-selection as individuals could still avoid coverage. Trust me, the recent health insurance industry's offer to abandon underwriting won’t apply to any post-reform system with millions still uninsured. But I would not count out efforts to waive underwriting rules for a one-time national open enrollment, similar to the original Medicare Part D enrollment, aimed at minimizing the anti-selection risk. It also appears that the original open-enrollment as part of the Massachusetts health law has not produced serious anti-selection issues from those who signed-up.
- Will There Be Teeth in Cost Containment Programs Like Pay-for-Performance and Comparative Effectiveness Research? – No teeth, no savings, hard to find the rest of the money.
- Which Providers and Beneficiaries Will Suffer What Cuts and How? – While I have suggested that the first $800 billion to pay for health care reform is in reach that still leaves us about $800 billion short. We won't get over the line without measurable provider and beneficiary sacrifice. This is the big one.
5 comments:
So you're declaring a public plan option dead before a formal proposal has even been made? Sounds like someone is trying to kill the idea for their clients.
You also ask "Which providers and beneficiaries will suffer what cuts and how? What about insurers? Shouldn't they suffer cuts too?
Anonymous - you obviously don't know Bob well. He is painfully plain spoken and is one of the few who 'tells truth to power'. before casting aspersions on his character or motivations, get to know him.
I don't agree with all Bob's views on the public option, as it does provide a meaningful, and I believe necessary, backup/alternative to private plans who have proven themselves all too incompetent. But his opinion is valid; there is open debate on the topic and it may well be that the public option loses in the Senate.
Joe Paduda
So, Anonymous, after a public option that is priced below market successfully drives all private plans out of business, to whom will they cost shift? Our grand children?
Mr. Laszewski's intelligent and knowledgeable identification of issues and resulting costs are needed to define what can be accomplished in a national health care program. I appreciate his clarity, and wish he would write more.
Believing, however strongly, that universal health care is the right of everyone in the United States does not match the reality of the costs of such a program. Financial facts must be weighed before laws are passed if any program is to succeed. There simply is not enough money to do everything the Obama administration wants. Either the U.S. will go bankrupt as we print more and more worthless money, or we need to use logic and facts to choose the best options we can pay for.
Please remember that of the 298 million people in the U.S. in 2006:
138.7 million were working
135.7 million paid taxes of $1,023,739,000,000
and the government spent $2,567,617,000,000
(http://www.gpoaccess.gov/usbudget/fy06/hist.html)
The people's rights to health care, like everything else, must eventually be backed by cash and not just emotion.
SHammer
A huge question is just how much dies the Medicare-like premium be? And, can it be age-based?
In general, Medicare folks cost more the older they get; however, costs do not really take off until the 80's. So, in general, the folks in their 60's are actually fairly cheap. I'm one of those. I pay an insurance premium of $74 per month, plus I think $94 is taken out of my SS check each month. But behind the scenes, the federal government is paying my HMO provider about $1,100 per month for me, as well. So, the total is about $1,250 per month for my health insurance: just for me! But I cost nothing like that, to date. So, what is the REAL cost of Medicare coverage after the profits of the private insurance companies and non-profits that "front" Medicare? That question needs to be answered; then we can get on to pricing a government alternative to private health insurance policies.
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