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California not really uber alles

Late last week Brian Klepper stirred things up around here calling California’s health care bill Business As Usual. Over at Spot-on earlier this week I was a little more simplistic. I call the California approach The Last of the Old Solutions, largely because it keeps intact the employer-based health insurance system and doesnt include an effective individual mandate because that needs a real tax increase. (My original title of "California not really uber alles”was somehow vetoed over there—but here I’m in charge!)

As I say over there

If the goal is universal coverage, the pay-or-play system in which employers have to offer coverage sounds good – as well as familiar – but it doesn’t really get us there. Hawaii passed something similar in the 1970s and several other states have tried some variant and still no one’s really got close to universal coverage.

Please go there and read the rest and come back here to comment if you’re feeling bored at the end of the year!

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Dr. Marcinko saysChris JohnsonMattMatthew HoltCurtis Recent comment authors
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Dr. Marcinko says
Guest

RE: California
Did you know that in the state of California, there is a Web site listing what discounts hospitals will offer uninsured patients. Applications for these programs are also available for download; and policies for about 82 percent of the state’s 405 acute-care hospitals are supposedly posted – to date – with more to come.
The site was enabled because of a 2006 law, the “Hospital Fair Pricing Program”, which prohibits hospitals from charging low-and moderate-income patients more than their highest rates charged to government insurance programs in which they participate.
Talk about price transparency – what do you think?
Best.
Dr. Marcinko
Atlanta, GA
http://www.HealthcareFinancials.wordpress.com

Chris Johnson
Guest

I agree with what Jeff and Matt have written. In a nutshell, the third-rail issue, that which no one will touch, is the basic observation that potential demand for services as we presently provide them is, for all practical purposes infinite; resources, of course, are finite. So somebody will need to list what’s covered, what’s not, and why. (For those interested in a recent and excellent debunking of alternative medicine, see “Snake Oil Science,” by a professor of biostatistics named R. Barker Bausell, Oxford University Press, 2007: I just read it, and it’s outstanding.)

Matt
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Matt

Jeff – I agree about what are you calling a significant recession? Given that is pretty unlikely, I don’t even think a mild recession in the U.S. next year will do much to change federal policies in regards to health care spending next year due to the following factors: 1. It is a presidential election year in ’08. Neither party will give the over party much ammo to work with. More posturing than substance. In particular, the early primaries this year will potentially expose the Democratic candidate to 7-8 months of attack ads. I just don’t see anyone rocking the… Read more »

Jeff Goldsmith
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Jeff Goldsmith

The most likely “left field” event, Matt, is a significant recession. Why is California running a $14 billion budget deficit? A housing driven economy is slowing down, and retarding state revenue growth. When states run deficits, cutting Medicaid is where you turn to balance the budget. If we have a national recession, you can absolutely expect Medicare and Medicaid spending to be reduced, or, more importantly, restructured. What the “Industry” wants will matter, obviously, in what is actually done. But as the Balanced Budget Act of 1997 demonstrated, even this gigantic industry can get rolled when there is a macroeconomic… Read more »

Matt
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Matt

If were are likely moving (like it or not) to the world of consumer-directed health plans, can we make the infrastructure for them work and provide the cost/quality information that consumers and employers need to make decisions. It also might not be a bad idea to actually design plans that don’t penalize first-dollar drug coverage and other preventative treatments.

Matt
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Matt

I emphasize with the politicians in CA who have legitimately invested a large amount of political capital the past 18 months. Nunez and Schwarzenegger have tried to set aside partisan issues to come up with a viable solution. However, given the pending budget shortfall and significant structural budget deficiencies, I am willing to bet the health care reform program in CA is a dead duck on arrival. Even if it passes, it is likely to get so get so mangled that it will be shortly ineffectual in addressing the uninsured in CA. I agree with some of the points made… Read more »

Matthew Holt
Guest

Until you connect the cost of care across anyone at a rational and visible level (and neither a Congressional or California budget nor health care hidden in the cost of employment is rational), it doesn’t matter what you agree to put in or out. Our system of government budgeting is to linked to taxes that anyone can easily follow. Our system of employment-based insurance similarly hides the cost. In New Zealand they know what the income tax rate is, and the government there knows that if they spend more on health care they’ll get booted out at the next election,… Read more »

Curtis
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We are still a long way off from universal healthcare. Jeff, I agree with your idea of a stripped down package. Universal coverage for alternative medicine is a joke and completely uneccesary yet is so often used as an argument agains universal healthcare. Why can’t we start from the basics and get that covered for individuals who cannot currently afford the ridiculous insurance premiums!

Jeff Goldsmith
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Jeff Goldsmith

Mathew, would you consider posting a link to the State Assembly’s bill so we eastern time zone types can read it for ourselves? Isn’t it interesting that the projected California budget deficit and the cost of the health reform program are both about $14 billion. So to fix both of them would thus requires the state to find a mere $28 billion? That’s the real reason it isn’t going to happen, not provider lobbying or employer intransigence. No state can really do something like this by itself without wrecking its economy. It is what we have a national government for.… Read more »