Don’t worry, the WSJ Opinion only makes sense because they let Zeke Emmanuel and Ron Wyden write an op-ed. The article is called Why Tie Health Insurance to a Job? and it’s impossible to argue with the logic about why we ought to move away from employer-based insurance.
There is of course an argument amongst those of us who both want to move to a social insurance system and want to have universal insurance as to whether this should be done in the voucher-type model that Emmanuel & Vic Fuchs have proposed (which looks a little like how the Dutch now do it) or whether we need to go to a modified single/multiple payer system like the French/Japanese/Brits/Australians.
I gave a talk in Canada the other night suggesting that there was some potential for convergence, and I used the very recent Commonwealth Fund data looking at the experiences of the chronically ill in seven nations. What is very interesting to me is that in terms of access to primary care and in terms of disease management, the Canadians and Americans look roughly similar—and not too good. As for specialty care, well as we know the Canadians & Brits ration by time and the Americans ration by money (or socio-economic status).
What was fascinating to me is that the data appears to show that the
Dutch have not only figured out access to primary care, but also to
specialty care, better than anyone else. And they have the least
pissed-off population, in terms of those who want the system completely
rebuilt. Only 9% of Dutch say that, compared to 12% of Brits, 16% of
Canadians, 23% of the French and 33% of Americans.
But are we going to end up with a Dutch-type system of highly
regulated insurers competing a la Enthoven (or a la
Fuchs/Emmanuel/Wyden) within a social insurance system? It certainly
doesn’t look like it—or not immediately.
Despite Wyden’s plan having a decent amount of bi-partisan support,
instead it looks like we’re going to a half-assed expansion of pay or
play—which, as Brian Klepper pointed out on THCB a few weeks back,
will still leave big problems and large swathes of uninsured as usually
small firms and those with contract or casual work-forces are left out.
Which probably means that the expansion of Medicare and Medicaid will
be the real result. I guess at least we know what to expect from
that—love ‘em or loathe ‘em.