Why I Believe That The Insurance Reform Is A Debacle
In yesterday’s post I said that I feel that the health care reform proposed as currently proposed will become the Democrat’s Medicare Part D, a boondoggle of enormous proportions, and one that will short circuit true reform. GeorgeSorwell called me out to back up this claim, so here I go.
First of all, here is a great tool by Kaiser that shows the key points of different proposals side by side. I am going to focus exclusively on the actual bills that will be voted on (i.e. the ones out of the committees) for this post, but you can also compare them to various Republican plans.
To me the primary considerations for health care are as follows: cost for individuals, cost for businesses, cost for the government, allowing economic mobility (going to school/starting a business/switching jobs/etc.), number of individuals covered, flexibility of treatment locations and providing enough economic incentive for people to work in the field.
At present, all of them except the latter fail miserably (except flexibility is provided by expensive plans) and nearly everyone agrees on that. However, the current proposals are going to make most of the facets worse. Normally I try to evaluate things from multiple angles, but in this case I’m going to stick from attacking it strictly from the left, using arguments from Physicians for a National Health Program (which in turn utilizes the CBO report for much of its argument). The reasons why I’m doing this are fairly simple: first of all they point out the features that I feel are similar to Medicare Part D and secondly, the program is a large expansion of the Federal role, so I’d rather tackle it from the question of whether the pro-government perspective believes it will work. This highlights a bias of mine, which is that I feel a lot of the gross inefficiency of the government and problems in the US are caused because we have many programs that are a hodgepodge of spending without having the internal ideological consistency to make them work.
The key to understanding the new plan is to understand the various sources of insurance. Good luck with that. Here is my best attempt:
Both bills mandate everyone have health insurance. If you don’t, under the Senate you will have a fine of up to $750 and the House is 2.5% AGI.
For the Senate bill, there will be the creation of new state-based “Gateways” that will be regulated by the government. Multiple Gateways can join up to form a regional Gateway, but it’s unclear what dictates that. In order to be part of a Gateway, the plans are through private insurers, and must have certain baseline coverage, as well as things like not discriminating against preconditions, no lifetime caps, reasonable premiums, etc. In order to receive tax credits or subsidies, the plan must be part of the Gateway. I believe that what they call the “community health insurance option” is the public plan that will be offered as part of a Gateway, and will compete with the private insurance plans. The bill doesn’t touch existing private insurance plans if they don’t want to be part of the gateway, other than to force them to have a few prohibitions on excluding pre-existing conditions and the like.
The House bill is quite different. First of all, it quite clearly says that individual insurance won’t count as part of the mandate unless you already have it. While the Senate version is trying to dissuade people from not using the Gateway by offering subsidies for it (and tweaking some rules), the House falls just short of outright banning them (kind of, in practice I’ll talk about why this isn’t necessarily so). This appears to be a national collection, not by state. Also, there will be a public plan that pays the same rates as Medicare, which is a provision not specified in the Senate plan. All plans (public and private) have to have four different tiers of coverage, and the Government will dictate the minimum things that must be covered for each tier.
For the rest of this post, I’m going to quote the Senate bill and then put the House differences in brackets because there are some important differences between the two, but the Senate is more likely to get its way.
When it comes to businesses, the bill mandates that all businesses that have 25 employees [greater than $250k of annual payroll] offer health insurance to all employees and pay at least 60% [65%] of premiums. Businesses will have small tax credit subsidies $1k for individuals, $2k for families [50% and decreasing on a sliding scale] as long as they have payrolls with average wage of under $50k [$40k]. I don’t know offhand how many companies those credits will affect, or how helpful they are, but the average wage seems awfully small to me considering the median income for men is $45k and the median for women is $35k, and is much less than individuals are given (more on that later).
I can’t figure out whether businesses will be required to have plans that are part of the new Gateways. I think that they will if the businesses want the tax credit, since individuals need to, but the ones without the credit I can’t tell. Obviously for the House version they have to buy into the national exchange.
The penalty for not getting insurance for the employees varies considerably. Under the Senate version, it’s a $750 fine, under the House it is 8% of payroll (well a sliding scale based on payroll when it’s less than $500k) unless it will cause job losses, then you can get an exemption.
When it comes to cost for individuals, the plan offers premium subsidies based on income level. The breakdown for the House is as follows (FPL = Federal Poverty Limit):
133-150% FPL: 1.5 – 3% of income
150-200% FPL: 3 – 5% of income
200-250% FPL: 5 – 7% of income
250-300% FPL: 7 – 9% of income
300-350% FPL: 9 – 10% of income
350-400% FPL: 10 – 11% of income
I’m not sure about the Senate but it looks very similar.
OK so that’s the root of the plan. It attempts to address individual cost by mandating how much employers must pay and providing subsidies for those people that don’t get insurance through work. It doesn’t really address the business costs for health care directly other than the idea that rates will be driven down in general. The government’s public option is supposed to be revenue neutral, with most of the cost coming in the subsidies and other facets of the bill. It would allow economic mobility by providing an option for all people regardless of circumstance, and theoretically this should help cover a lot more people. Flexibility in services is hard to address, as that looks like it’d be highly plan specific. While the public plan in the House would limit the amount paid to Medicare, it’s unclear how the Senate version would work, so I can’t really tell how it’d affect the medical service providers.
Now for the problems.
Medical costs are rising far faster than incomes. This plan is projected to do little to curb cost inflation over the long run according to the CBO and since all the limits for individuals are based on income, this means that the subsidies will increase very quickly. However, raising on individual taxes to fund these extra subsidies is basically out of the question, and the taxing of business provided benefits will merely cause them to drop coverage and pay the $750 fine (I’m assuming the Senate version is passed, even if the House is, the 8% of payroll would be cheaper to hand over than insurance plus taxes). Since the bill purports to have a cap on spending, this means that subsidies will have to decrease very quickly, and threaten the affordability for individuals.
Moreover, the Healthcare Gateways are flawed in their conception. Sure they encourage people to join them to get the subsidies, but the mandated coverage in several tiers and caps on deductibles will make those plans rise far faster than the private plans outside the Gateway (which is why the House bill says you have to be part of it to not get penalized…although at some point it’d be cheaper to take the penalty and have individual, high deductible insurance) and an attempt to limit those costs will lead to randomly changing coverage. This is exactly what is happening with the Medicare Drug Bill, where medications are added and removed all the time with no warning, and it’s nearly impossible to make sure you have the coverage you need. All of this will cause healthy people (and many businesses) to drop out and go back to the unregulated market, which causes adverse selection and breaks down the Gateway. How do we know this is a possibility? Because it’s already happened.
Ironically the public plan that is so decried as socialism is nearly toothless as it has none of the qualities needed to distinguish itself from the private insurers. So according to the CBO, we are going to spend $600 billion to $1 trillion over the next ten years for a plan that will only cover a few million more people than are covered now, and will fragment the market even more. It’s unreal that most of the rhetoric is either for/against government health care, but in the Senate version, the government’s role is almost exclusively to just write the checks (the other major flaw of the Medicare Bill).
It is obvious that the root of the problem is cost, and that’s what we should be tackling first and foremost. If the government is going to get involved without having a single payer system, it’d be a much wiser use of money for the government to start giving out awards/increasing research budgets to create new technologies that are then licensed by the government or non-profit cooperatives. They could also provide catastrophic insurance coverage for major illness, while encouraging high deductible filler plans to cover things in between and regulating those in some ways, while reducing regulation (like the geographic regulation) in other ways. That way, non-profit insurance collectives would have an easier time forming, as it would be much less likely for them to get wiped out due to a small percentage of the pool getting a chronic illness.
Anyway I think this is enough to start a discussion.
24 Responses to “Why I Believe That The Insurance Reform Is A Debacle”
Nice start, but I think the first step is to extend healthcare coverage to as many people as possible as quickly as possible. Neither the public or private sector has contained costs for the past 20 years and the ways to do that are very different and open to debate and eventual experimentation. A public plan does not require a public entity. The Swiss requires all private insurance companies to offer a basic plan for specific premiums and subsidies premiums for low-income people. The private health insurance can compete to offer additional benefits. Yes, everyone is required to buy insurance – so the healthy 80% support the sick 20% – but there is not a bifurcated private system with a public system for the old and poor as in Medicare/Medicaid. Your post does not address political realities that so much can be accomplished in a country dominated by a fractured public, multiple large players with bags of campaign contributions, and misinformation from all parts of the political spectrum. I favor doing something now, and doing something in 2011, and every 2 years, experimenting as we go. As far as budgetary deficits are concerned, I am concerned but who knows what will happen in 10 years. 1/3 of the current federal budget deficit is due to the current severe recession, 1/3 is due to prior tax cuts, and the rest to other factors including new spending by the prior and current administrations. No one wants to admit that taxes must go up on everyone, not only the rich, to pay for the government we want. In addition, the $1 trillion price tag is the estimate for 10 years, nor just every year. If we can spend $100 to $150 for a War in Iraq each year, we can spend the same amount covering all Americans with healthcare insurance. Keep up the good work – your fellower contributor from Phoenix, MP
Don't get me wrong, there are some things that I think are very good in the bill, such as requiring insurers and hospitals to start tracking procedures and outcomes so we have a better idea of what works and what doesn't. I also like some of the incentives for solutions for efficiency (for full disclosure I'm actually putting together a business proposal to start a company that does exactly that). I just feel that the subsidies are completely misguided as it's throwing money down the drain and I don't believe it will “cover all Americans,” indeed according to the official analysis it will help less than 10 million!
I think they should just drop the subsidy part and adopt a more targeted bill that brings the individual market into the HIPAA standards and some of the stuff I just mentioned.
Are they affiliated with the health giant Kaiser-Permanente?
Who? The single payer people…uh I seriously doubt it. The tool is though, but that's just the text and no analysis.
Really nice post Mikkel and great link (FYI for later poster, Kaiser Foundation has no affiliation to the insurance company other than being founded by the same family … they haven't had a fomral connection for decades)
But I would agree that we simply can't ignore the uninsured as they are directly contributing to the increased. Not to be anectdotal and uncited (but I will anyway), but a hospital in Detroit swallowed $32 million last year in expenses covered the uninsured and underinsured. This year that number is expected to rise to $72 million. That cost falls on other patients, and reduces the ability ot invest in information technology and other crucial infrastructure needed to reduce the general costs of health care. By providing some form of coverage, we can decrease the general costs of those patients by getting them care earlier.
I do hope this is addressed through the development of non-profit co-op health groups, but that will probably be decided by the political winds. Sadly, no one is differentiating that in the public option description from “government-run health care” perceptions.
Thanks for the great link Mikkel. It will take a lot of time to digest all the comparisons. The preference for me would be Sanders plan, although it is missing some crucial dollar information in this comparison. It appears to be the simplest in form and implementation. Its also a non-starter, thanks to $1.4 million a day in insurance money being spent to sway this conversation.
[...] proposed will become the Democrat’s Medicare Part D, a boondoggle of. Read the rest here: Why I Believe That The Insurance Reform Is A Debacle | The … Leave a [...]
In 2005 the Kaiser Family Foundation issued a report entitled “Ten Myths about the Uninsured“:
This report (a small 161kb .pdf file) should (but probably won't) point this debate in a more productive direction.
That sounds about right. In fact I was going to put up another post discussing how we have to look at the amount spent by the entire system and fallacies that arise when you don't. I just don't see how this convoluted plan addresses that.
No Patient Left Behind :
Part 1.
According to the scoring of CBO on the prevention & wellness program, all fitness centers around the world should close down immediately and all media have to end reporting health tips about prevention.
Immune System & Levee System :
All of the excellent health systems seem to have one thing in common, a expansive, systematic preventative program requiring immense investments. I think a prevention system works as a 'levee' built against flood by the government, similarly, it also needs non-profit investments from the government 'on a large scale'.
This might offer us the clue of why all of the free states have public insurance policy in place.
It won't be easy to draw some specific numbers on the economic effect of the 'levee' , but the flood measure lacking a stable 'levee' would be a house on sand, as the too high level of 'preventable' chronic diseases in America shows.
At present, about 75 percent of each health dollar goes to treating chronic conditions.
When tests reveal patients are at risk of a chronic disease, physicians have no benefit to help them make necessary changes to stay healthy. Rather, the system today is designed around treating patients once they become sick.
If current health care system could shift a small percentage of total spending into programs that help prevent people from getting sick in the first place, in combination with the KEY 'pay for OUTCOME' reimbursement reform based on IT SYSTEM, it would dramatically reduce the overall cost of care.
Thankfully, the health care reform bill currently before Congress makes several key investments in preventive care, and those pieces of the PUBLIC OPTION must be maintained.
“An ounce of prevention is worth a pound of cure.”, said Benjamin Franklin , and 'Early Detection' goes beyond monetary value as we see the recent case.
As far as I'm concerned, the congress affected by the special interests has impeded the budget request for prevention program in Medicare & Medicaid. Let's imagine the costs and invaluable lives following the levee breach.
Time is ripe for CHANGE !
To see the forest, get a big picture, massive job creation, promising stem cell research, several times more economic effects of 'from bed to work' , relief on the mental stress and keep-eating-habit caused by deep-seated financial anxiety, which are the epicenter of a number of different diseases, and beyond lie ahead, to be sure.
Part 2.
The 'innovative' idea of a 'pay for value / outcome' pack came after the CBO had previously pointed out this health care reform wouldn't work without 'fundamental' change in the out of date system. It is said that as much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the recipients, and this 700 billion dollars a year can cover a lot of uninsured people.
(Please visit http://www.kare11.com/news/news_article.aspx?st… for detailed infos).
The expected Benefits of this 'innovative idea' are as follows ;
1. Meet the objective of revenue-neutral.
Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve'
care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
wealthiest. Supposedly even the 'conservative' number of such savings might be able to meet the objective of
revenue-neutral.
2. Quality and affordability.
If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to
prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary risk-carrying
procedures.
3. No intervention in decision-making.
The innovative idea of 'a pay for outcome' will more likely prompt team approach and decision, as at Myo clinic.
Under the 'pay for outcome' pack, for good reason, best practices as 'recommendations' would simply help them
make a better decision, and the government won't still have to meddle in the final, actual decision-making
process as a non-expert.
4. Speed up the introduction of IT SYSTEM.
The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM.
The synergy effect of the combined Health Care IT & a pay for 'outcome' system may allow the clinicians to
'correctly' diagnose and effectively treat a patient earlier in the process so that it can measurably scale back the
crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.
5. Accelerate the progress in medical science, in return, it saves more cash.
6. Settle the regional disparity.
7. Reduce the emergency room visits & save immense costs.
Public health insurance plans such as Medicare and Medicaid paid for more than 40 percent of U.S. emergency
room visits in 2006, according to government figures released recently. Many experts say reducing these hospital
visits would be an important way to lower the enormous, and growing, expense of U.S. health care.
I share the opinion that unlike the insurer-friendly senate plan by 'some' members, only a strong public option will be capable of getting the premium inflation under control and saving the U.S in turbulence.
To my knowledge, a dual system tends to deliver better results than a pure single payer system. Supposedly, to be or not to be might be up to the innovations like a pay for value program, otherwise, the forthcoming start-ups may fill the void with competitive deals. The competition based on 'fair' market value would be a beauty of true capitalism, not monopoly, an objective for anti-trust.
Part 3.
Science / Innovation Key To Recovery !
1. The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM so that it can reduce the redundant work burden, focus physician's effort on patients, and store patients' informations to skip the repetitive and painful procedures.
2. The synergy effect of combined Health Care IT & a pay for 'Outcome' SYSTEM may help the clinicians correctly diagnose and effectively treat a patient earlier in the process so that it can measurably scale back the crushing lawsuits and deter the excuse for unnecessary procedures to make fortunes.
3. In modern society, 'medical institute' and 'energy sector' is the only arena that is not retrofitted with 'a must' . And what happens if the financial institutes get back to the PRE- IT SYSTEM ? , supposedly the crisis would be comparable to the present health care crunch. Unlike the numeric errors, medical mistakes, in most cases, is fatal to patients. It is believed that over the duration of two wars, computer IT has not expanded the progress to 'electronic medical records' & ' smart grid technology' . With them in place, people all around the globe might have avoided this tragic recession.
4. The Mayo Clinic medical practice has embarked on the first widely available e-health information service for patients on Microsoft's HealthVault service.
Through Mayo Clinic's network, users of its health-care services can keep up with their health information and information for family members, and receive health guidance and recommendations from Mayo that is optimized for each person.
The system also allows patients to upload information from home-health devices such as blood glucose monitors and digital scales. Patients can authorize whether they want to share their health information with doctors or other caregivers, and those caregivers can provide health-care and general wellness recommendations based on the information patients provide
Part 4.
-Scare tactics from verbal to physical-
1. 'Takeover and Rationing Cliche' lost ground, as this spoiled menu did the opposite for too long.
Like freedom of press, Public Well-being as a right, a nation took root in every free nation as a natural part of life.
The debate about it is most likely to puzzle people all around the free states. And with so many people uninsured
or underinsured, the humanitarian foreign aid ahead will confuse them, too.
2. Arbitrary Market Theory, Not Fair Market Theory, should not apply to a fundamental human right.
This last spring, due to the demand decrease, the peak fuel price came down below $40 per barrel, though, the
'Similar' insurance premiums keep on rising, accordingly the inaction could bankrupt family, business, and
government 'BEYOND this recession' , as all across the spectrum agree.
Basically, as demand diminish, the price tends to reflect it, nonetheless, the insurers that formed a cartel through
consolidation have replenished the loss by exercising inhumane malpractices involving denying, capping, rapid
premium increase and the like. And this runaway premium ended up in the collapse of middle
class ranging from finance to mental health, alongside the peak fuel price and fast-growing mortgage rate, as all of
us know.
They could be cited as an objective for anti-trust or anti-corruption.
3. The Deficit-sensitive groups have a distinctive common ground, they all have a Deficit-driven background out of
question. Therefore, I'd say they have nothing to say about deficit unless they come up with a legitimate plan.
4. These Deficit-sensitive and yet Deficit-driven allies struggle to ignore the positive effects involving massive job creation,
promising stem cell research, several times more economic effects of 'from bed to work' , relief on the mental
stress and keep-eating-habit caused by the deep-seated financial anxiety, which are the epicenter of a number of
different diseases, and beyond, as in the case of sustainable energy investments & the following savings.
5. To see the forest, get a big picture, it might be a way to go.
German firms on Monday 13 July launched a renewable energy project designed to provide European households
with electricity from the Sahara.
Utilities giants RWE and E.ON, electro-engineering group Siemens and Deutsche Bank are among the dozen
companies involved in the 400- billion-euro (552-billion US-Dollar) Desertec Industrial Initiative Dii.
Using high voltage direct current transmission lines, the energy could then be transferred to Europe where it could
supply 15 per cent of the continent's electricity needs.
Thank You !
If I'm understanding that excerpt, Steve, they're saying that covering the uninsured will cost more (a 3% increase estimated from what our current total health care costs are) but that degree of increase isn't as big of a deal as opponents make it out to be. Is that a correct interpretation? (I may be a little slow this morning as I'm not able to have caffeine right now!)
If so, OK…but that's still a 3% increase, and they also mentioned that doesn't include the administrative costs of getting those additional people in the system.
I don't mind people setting the record straight in response to people who exaggerate- but from what I hear from a lot of people who support universal coverage, there's also been misinformation on the other side so that some people believe that covering everyone will actually REDUCE costs overall (they generally seem to think this is because preventative care is cheaper than going to the ER, which doesn't prove true in the aggregate.)
Thanks for mentioning me up there.
I confess I look at Medicare Part D a little differently than you do. You see it as nothing more than a government boondoggle. I see it as a Republican boondoggle, passed through lies and evasions to satisfy short-term political goals without regard to long-term consequences.
Considering the costs, maybe the Democrats are trying to do the impossible in this bill. But the Democrats are, in fact, struggling to be responsible about the costs, reflected in the CBO numbers. That's why I dislike your analogy to Medicare Part D. In short, I see Medicare Part D as Republican business as usual:
People who aren't covered by insurance go to the emergency room when they are sick. Many of them can't pay. People who aren't covered by insurance suffer catastrophic illnesses and accidents and go bankrupt, meaning they don't pay for everything. Hospitals still have to recover their expenses, so they increase their charges to people who can pay, which is you and me and everyone else covered by insurance.
I guess I could go into greater detail, but surely you see the gross inefficiencies in this (non-government) hodgepodge.
I'm sure you're not defending what we've got.
I appreciate your substantive response. But I hope my own point is clearer now.
Yes, I think that is the correct interpretation and IMO this is just one of the ten myths exposed.
This study was not done by PR firm of a group with an agenda it was done by a respected and knowledgeable organization in the business of health care.
If you read the entire “Ten Myths about the Uninsured” article you saw anti-health care talking point after anti-health care talking point shown to be nothing short of dishonest, misguided misinformation.
No, the 3% increase is AFTER including administrative costs. The figure that does not include them is the $48 billion figure.
That doesn't make sense, Steve. $48B is about 3.4% of $1.4T…so I'm assuming that they rounded down and that they're using 48B and the 3% figure to represent the same number.
It can't be that the 3% represents costs WITH admin expenses but the $48B does not, because the $48B is a slightly bigger number than the 3% one is.
Either they both represent costs with admin costs or they both represent the pure provider payment cost without admin- and from the wording it looks like it's the latter.
CStanley, It might not make sense to you but if the “amount of additional health spending to cover all of the uninsured” was NOT relatively small I don't think they would have called it a “myth”
Steve, I wasn't saying that their comment didn't make sense- it was yours which can't possibly be correct (48B is bigger than 3%, not smaller than it, so it can't be that the 3% includes admin costs but the other figure does not- which is how you interpreted it.)
Anyway- I'm also not disputing that they debunked the idea that the expanded coverage for all would be a huge additional expense. I was just also pointing out that there's a counterpart to that myth on the other side of the debate, which is that covering all the additional people would save money instead of costing more.
It still remains true, even according to their figures, that the goal of covering everyone adds costs, not subtracts- so if we're going to pursue both goals of expanded coverage and bending the cost curve, we have to get much more serious about cost cutting than the currently debated plans do.
I also meant to point out that that mythbuster disproves what GS is arguing. They're saying that it's not true that the burden currently of paying for healthcare for the uninsured is that high, and also not true that most of it is shifted to private insurance premiums (what isn't paid by the uninsured patient is mostly subsidized by the govt now- so the proposals just shift from paying their healthcare bills directly to paying for their insurance premiums.)
CStanley–
I presume you're referring to Myth #9. (Honestly, CStanley–would it freakin' kill you to specifically cite your source??? I have been complaining about this for FIVE years!!!)
Myth 9 ends by saying 85% of uncompensated care was paid for by a variety of sources, including federal and state dollars.
Eighty-five percent.
In an effort to make what I am saying plain, I'm going to italicize my next sentence here.
That means there's still 15% left to recover.
Right?
Anyone care to guess where it comes from?
I am sorry if this seems like shouting.
I too would like a perfect health care reform bill.
Actually I see it the same as you George. I kept track of all that at the time, so you don't have to convince me of anything.
That said, I have a saying that it seems like the Republicans have policies specifically meant to help major corporations and the rich without regard to everyone else by design, while the Democrats have policies that try to help everyone by design, but only help the rich and major corporations because of unintended side effects and “compromises.”
This that an unfair generalization? Yeah…slightly, but not by much. In most cases.
My problem with the Democrats in general about nearly everything (the climate change bill and stimulus had this problem too) is that they are such cowards.
So many of their ideas start out trying to do something, but by the time they make changes to satisfy conservative Ds, to make it look bipartisan, and to reward all the backroom dealing, then the programs aren't ideologically consistent anymore. The end result is that they cost a lot of money, have lots of regulation and have gapping holes or hand outs that don't add up to much.
Then, even though the deals were made originally to “compromise” and have a more “centrist” bill, when the programs don't work they are attacked as showing that the government is incapable of doing anything. Well yeah it's incapable when it has policies that don't make sense. Which is what they post was trying to show.
Obviously I'm not defending the status quo, but according to the official analyses, few people are going to be added onto the rolls through this bill, so your point about the uninsured is a bit of a non sequitur. When I talk about the cowardly Democrats, I'm also not saying that it means that they have to be Leftists…I just am demanding logical consistency. My proposal at the end is the type of compromise that I feel is the “good” type because it seeks to address both the free market/competition viewpoint and the fact that the real hurdles for smaller and less profit seeking insurance comes from catastrophic cases. Of course the numbers would have to be run and maybe that too is unrealistic, but at least it could work in theory.
Exactly cs. I am thinking of writing a short addendum post that mentions this. I think I'll do so now actually.
Mikkel–
Thanks.
Since you accused me of non sequiturs, though, I noticed that you buried your support for a single payer plan at the end of this post.
A post where you laid out the case for a single payer system would be fantastic!
I will write it at some point this week, but it is a tricky post to write. The fact of the matter is that I don't believe that a single payer plan is sustainable either without major reform across the board…not just medically but socially as well.
I'm going to be very blunt…when you look at the population pyramid, the low projected growth rates over the next decade or two caused by the massive and still exploding debt, and increasing basic material problems, the world is going to have extreme challenges over the next 50 years that will lead to a decrease in standard of living by a ton. The question is how we respond to it.
I believe that we need to move away from a pro-growth economy to a pro-efficiency economy, but this would require massive political, monetary and social changes. One of the cornerstones of that is a single payer system (with private insurance as an add on if you want to buy it…I'm very against banning the private market entirely) simply because it has the ability to be far more efficient. However at present I think it'd be a disaster because it would contribute to some of the problems.
Physicians for a National Health Program supports widespread reform to the practice of medicine in addition to the adoption of a single payer public insurance program, including the organization of team based care practices and salaried payment of physicians ( as opposed to the fee for service payment systems that today rewards excessive use of care) for much more efficient delivery of care.
The private market insurances have not shown themselves to be more efficient in the delivery of care than government programs. In fact, because of the deliberate administrative complexity they introduce in order to erect barriers to their medical losses (payment of claims) and thereby increase their profits, they are considerably less “efficient” in the delivery of care. It is in their fiduciary best interest to continue that practice.
If anyone here believes that the moneyed interests who are controlling and corrupting the current health care reform debate are powerful now, just wait until every American is required to have insurance and pay into their coffers even more. The currently proposed reforms in the Senate, other than the Sanders bill, would likely be a step backward in the cause of efficient, socially just and human health care in America. At worst, they will even further undermine public trust in government to administer coherent and economically sustainable programs.
One political consequence of fragmenting the entire US population into customer cohorts for market based insurance is that it further fragments political will into the “customer vs the company” on payment for services. Alternately, a public program such as Medicare provides a large, unified risk pool of people invested in maintaining quality of coverage. Going in the market based direction destroys political will, going toward a public plan enhances political will by providing a target that is mandated to be accountable to it's beneficiaries, not to profit seeking shareholders.
It is correct that here is no proven overall savings to preventive care. A few preventive measures in pediatric care (notably immunizations against infectious diseases) and a limited savings in ER costs have been shown, but most preventive care costs more on a systems level, not less. Doctors subscribe to it because of the benefit to the small number of individual patients who will benefit.
As Senator Chuck Schumer has privately said to single payer advocates, “You people will be the last left standing.” because only single payer will work in the long run. How many people will have to suffer and die in the interim? That's up to the vagaries of political will in the US.