Things I've been reading lately:
From the Washington Post: The Healthy Americans Act, sponsored by Senators Wyden (D-OR) and Bennett (R-UT) is still alive and kicking. It's an innovative proposal to "blow up the existing health insurance system," and replace it with a public-private partnership providing universal coverage administered largely by private insurers. Best of all, it eliminates Medicaid (!), which feature alone makes me want to support it.
According to Ezra, Sen Wyden spoke today at the American Health Insurance Plan's conference, speaking to the insurance industry executives, with a surprisingly warm reception. "If your profession decides – as it did in 1993 and 1994 – to go out and spend millions of dollars fighting to preserve the status quo, you may delay reform for awhile but you will increase the likelihood of a government run health system with no role for the private sector.” There is growing support from unlikely industry sources for this sort of health care reform, including large employers like GM, the small business associations, and the SEIU and other labor organizations. If the insurance industry's opposition is co-opted by mandates (which would greatly increase the size of their customer base) and subsidies, that would go a long way towards removing obstacles to reform.
DemFromCT over at Daily Kos published a thoughtful and surprisingly non-partisan, neutral diary on the prospects for reform and the dueling priorities that different players have. Kevin will be pleased to see that single payor was preferred by only 15% of respondants to a survey.
And while we're perusing the Great Orange Satan, jd in nyc has an insightful post on how multipayer universal healthcare works in other countries and the lessons we might draw for US healthcare. Key graf:
The first wave universal healthcare system in the U.S. will expand, not shrink, private health insurance. You have nothing to fear from this, so long as ... a few simple rules are followed.The counterpoint to that is Ezra's op-ed piece, Why health insurance doesn't work, which describes the current perverse market incentives which drive bad behavior by insurers. Key insight:
- All individual insurance is guaranteed issue: no insurer can turn you down for coverage based on pre-existing conditions, nor can it drop you once you get sick. When the insurer can't get drop you, it immediately has a much stronger incentive to take care of you. A stitch in time saves nine, and all that.
- All individual insurance is community rated: insurers can't charge you 10x as much as your neighbor because you are 50 and have diabetes, whereas she is 25 and has no illness. Large risk pools are created so that the healthy subsidize the sick.
- The cost of insurance is determined by ability to pay: the poorest get it for free, and lower income individuals have a sliding scale of subsidization.
- Individual and/or employer mandates: if a substantial number opt out of the system, they are disproportionately likely to be healthy and/or poor. each group causes its own escalating problems if allowed to opt out, so this must be strongly discouraged by making it never to one's financial advantage to do so. Penalties must be higher than the cost of coverage for your income bracket (or firm size).
- Universal, standard basic insurance package: this has the benefit of ensuring everyone has real health coverage and not crap insurance, and it also lets every provider know a large range of things that are going to be covered no matter what. It dramatically reduces bureaucratic complexity from what we have now, even if it isn't as simple as single-payer.
- Some means of comparing and purchasing insurance options in a straightforward and transparent way: self-explanatory, I think. This was the national insurance exchange in Clinton's 94 plan, and is the Health Connector in Massachusetts' current system. Universal access to FEHBP fills that role in Clinton's new plan.
- Some additional set of mechanisms for rewarding insurers for helping people to be healthy, but not for enrolling a disproportionate number of people who are already healthy: the idea is to discourage cherry picking, which is hard to do in a guaranteed issue system but possible, and encourage wellness and disease management activities on the part of insurers. There are several options here that I won't go into.
Health insurance ... is a form of risk pooling that individuals use to smooth out lifetime healthcare costs. Heath insurance does not insure us against risks so much as it insulates us against costs. We pay regular premiums so we don't have to directly pay for irregular care.'nuff said.