Several stories in today’s papers make it clear that the atmosphere for health reform today truly is different than when the Clinton Administration took over in the 1990s.
Here’s the bullet points in support of that thesis:
- Obama selected veteran policymaker Tom Daschle to head up the Department of Health and Human Services, signaling he wants the former South Dakota Senator to head up reform efforts.
- The Washington Post quoted Sen. Ron Wyden
(D-Ore.) saying, "Tom Daschle sees this as a once-in-a-lifetime opportunity. On the premier domestic issue of our time, the
president-elect sees Tom Daschle with the skills and abilities to bring
people together and get this over the finish line." - Marking a clear deviation from the past, the Association of Health Insurance Plans announced
it would be willing to accept guarantee issue and community rating in
exchange for a mandate requiring all people to buy insurance.
- Seven Senators promised to work together on health care to accomplish something next year. They are: Max Baucus of Montana, Christopher J. Dodd of Connecticut, Edward M. Kennedy of Massachusetts and John D. Rockefeller IV of West Virginia, all Democrats, and Michael B. Enzi of Wyoming, Charles E. Grassley of Iowa and Orrin G. Hatch of Utah, Republicans.
- But Bob Laszewski provides WSJ readers with a reality check, "Talk is cheap on the front end of this thing," he told the Journal. "The
rubber hits the road when that 1,000-page document comes out with
specifics."
“Marking a clear deviation from the past, the Association of Health Insurance Plans announced it would be willing to accept guarantee issue and community rating in exchange for a mandate requiring all people to buy insurance.”
Clear deviation? From what, continued profits? Mandating people into an overly costly system won’t solve the afforability crisis. Isn’t this just a ploy to have government shore up declining premium payers? Why don’t we mandate everyone buy a Detroit built car if they promise to continue to build them?
Such a payday! Think of the premiums! What’s that? 47 million uninsured? Multiply that by what? Whooo Hooo!
Growth in the commercial market for health insurers has ground to a halt in the last two years. All of the insurers are looking to the government markets for growth. No wonder AHIP is supporting guaranteed coverage inside of a mandatory insurance framework. It opens whole new markets, that may be subsidized, to the insurance industry. Let us hope that Daschle and the Congress restructure the health care system for the benefit of the consumer and the payors and not for the further benefit of the “industry”.
I agree with all of the above.
I fear that the for-profit insuers are part of
the push for Universal Coverage Now. They are
desperate for a payout.
But health care reform has to be done carefully,
to insure that private insurers are operating on
a level playing field with a public sector insurer.
This means regulating them. And while they say they are willing to cover everyone, they are Not agreeing to
Community Rating. (See Ezra Klein’s interview today on American Prospect.) In other words, they want to continue to gouge the sick. Sure you can have insurance–for $30,000 a year.
This is not a departure from their past policy.
Figuring out how to regulate the insurers, battling their lobbyists, and battling the lobbyists representing all of the people who do not want to see costs contained will take time.
I very much doubt all of that can be accomplished next year while also preparing to get out of Iraq, facing the economic crisis, etc.
I like Baucus’ suggestion that we expand SCHIP and Medicaid first, and if possible, let people 55-64 enroll in Medicare. Though Medicare will need to figure out how to attract healthy 55-64 year olds. They’ll get sick people who can’t get coverage in the individual market, or are underinsured by their employer. They’ll need more healthy people to pay for them– or Medicare will go broke.
Of course, there are many points of disagreement on healthcare reform and numerous difficult decisions and compromises to be hammered out. But there’s also widespread agreement on at least two critical reform requirements.
– Electronic health records (EHR). Bringing together the major medical systems has been a priority of current HHS Secretary Michael Leavitt, and will likely be backed by his probable successor Tom Daschle. EHR adoption is still low, so the opportunity is real and big.
– Evidence-based medicine. Stakeholders agree that all efforts and systems should be based on sound medical science and published literature. The new systems need to assure and deliver quality, consistent care, incorporating the best diagnostic and quality care guidelines. These guidelines need to be available at the patient’s bedside as well as throughout payer and provider organizations.
These two concepts give us a starting point for the emerging health reform compromise. I’m looking forward to seeing more points of agreement emerge as the reform conversation gains volume.
Possibilities? http://www.healthcaretownhall.com
Could anyone on THCB (my favorite would be Maggie Mahar) give a brief run down (as a separate post) of Daschle’s book, and how much it squares with Obama’s statements? What does he write about cost control, which many (incl. myself) think is a crucial issue?
I am not a big fan of AHIP, but I agree that you can’t have community rating and guaranteed issue without mandates that everyone has coverage. We can’t allow people to take advantage of the system by not obtaining coverage until they develop a serious illness. That’s why I cringe when the topic of eliminating pre-existing clauses comes up. People would abuse that in a big way.
As a medical group administrator, I’d be lovin’ life if if everyone had coverage because it’s a lot easier to collect from a third party payer than it is to collect from an individual, regardless of macro-economic conditions. As a citizen, I’m not in favor of using more tax dollars than we currently are to cover my fellow citizens.
Let’s work on driving down the costs of our system to allow for more people to get coverage that were previously priced out of the market. While we’re working on that, I’d be in favor of temporarily increasing the Medicaid income limits as a “bridge” to buy some time.
Deron, community rating is an insurance invention to guarantee profits as is pre-existing conditions – it is not a healthcare solution. Unless you tax people the equivalent of the premium they will calculate the least cost alternative to decide whether to participate or not. At present people WITH insurance are putting off elective surgery and primary care because they can’t afford, or are afraid to afford, the co-pays and deductibles. Driving down costs is not in self the interests of the industry.
Just how high would you propose to raise the Medicaid limits, which by the way is not healthcare, but tempory sickness intervention.
When you consider that Canada spends 2/3rds (per capita) on health insurance and covers everyone, you can easily see that “free enterprise medicine” is the most expensive system there is. Even Switzerland, who has a system much like what Hillary Clinton offered us back in 1993 only pays 3/4ths of what the US does on a per capita basis. So where does the extra money go?
Peter – When I mentioned increasing the Medicaid limits, I was referring to the income limits. In other words, I would be ok with increasing the income limits temporarily while we work on driving down costs.
I wish you were correct about Medicaid being “temporary sickness intervention”, but you’re not. Medicaid is becoming a way of life for many. It is far from temporary. What you describe is the probably the way it was originally intended, but it’s not reality at the present time.