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POLICY: Centrist democratic policy wonks talk shop

The Century Foundation has a discussion from a bunch of health care policy experts/pundits about the latest developments in the health reform “debate”. Given the large cast of characters (inc Aaron, Hacker, Relman and younger punks Cohn, Klein et al), it’s interesting stuff, but not exactly as diverse as say Cato’s recent back and forth! Yup, it’s a bunch of DimmyCrats talking to each other, but smart ones. Here’s the document. (rather annoyingly it’s a PDF).

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jdBarry CarolMatthew HoltMartin JamesEric Novack Recent comment authors
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Barry Carol
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Barry Carol

One follow-up point. We would probably also need to make sure that people with substantial non-wage income (interest, dividends, capital gains, rent) do not get a free ride for their health insurance. At the very least, they should be required to buy it for its full cost or something close to it. This would be similar to the rules starting to phase in this year that require upper income elderly people to pay more in premiums for the Part B portion of Medicare.

Barry Carol
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Barry Carol

jd, Yes, I’m suggesting we need a 15% payroll tax to cover the 150-160 million people who currently get insurance through their employer plus the 47 million who are currently uninsured. I’m assuming that, to the extent, some of the people who are working for low wages would meet the eligibility criteria for Medicaid, they would either get their insurance through Medicaid or Medicaid money would help pay for their employer coverage. I further assume that the military personnel would continue to be covered by Tricare. I’m also assuming that out of pocket costs for deductibles and co-pays (including tiered… Read more »

jd
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jd

Barry, If I understand you, you are suggesting that without real reform of the cost drivers, the cost of covering everyone will push healthcare from 16% of GDP to 24%. My first response to that is revulsion, though I know full well that this is the path of least resistance to universal coverage and that it will eventually trigger reforms that get the total cost down. As for the mechanism for funding universal coverage, I’d like to know more about why you think the payroll tax would be 15%, when France and Germany are only slightly less than that and… Read more »

Barry Carol
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Barry Carol

I was actually surprised by the discussion. My impression was that most people are in favor of universal coverage and generally support community rating. The challenge, and this is where I think the debate has been weak so far, is finding a credible way to pay to cover the uninsured and improve the employer based system. The notion that we can free up huge resources by eliminating the private insurers and their administrative costs I think has been debunked on the earlier thread. I think the penalty for not acquiring insurance under the Massachusetts plan is pitiful, and California’s proposed… Read more »

Matthew Holt
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Eric–Not a pure Canada style single payer PNHP advocate in the crowd–even though MOST Democrats as polled want that! That’s centrist for you

Martin James
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Martin James

If the share of cost from high utilizers has been steady for 25 years, then they can’t be the “driver” of cost increases. Its not that the sick are that much sicker, its that the cost to serve everybody has gone up.

Eric Novack
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1. given what that group wants, I am not sure “centrist” is the appropriate word. It also makes me wonder what “left” or “liberal” or “progressive” viewpoints are. Perhaps someone can enlighten me there. 2. the group missed the recent long debate over administrative costs– a discussion that THCB readers have really got a hold of— but I think everyone is now disabused of the notion, as said in the attached discussion, that admin savings could be up to 30% of total costs. 3. interestingly, the VA and Military system was brought up as ‘good models’– yet nowhere was a… Read more »