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Herzlinger–Enthoven was right all along

In a blog piece called Why Republicans Should Back Universal Health Care Regina Herzlinger says something that I more or less agree with. Switzerland’s system isn’t a bad option. Neither for that matter is Holland’s. Now of course Maggie Mahar has debunked Herzlinger’s notion that there isn’t state regulation of insures and providers in those systems. And Regi also talks a lot of tosh about Medicare, the UK and the evils of the government in the same piece. But I guess she feels she has to do that to keep whatever’s left of her audience (that would be the four Republicans who care about health care, rather than the health care business types who have moved on in pursuit of who now holds the purse strings).

But I’m just left with one little question. Where’s Herzlinger’s mea culpa to Alain Enthoven? After all he’s been promoting the Dutch answer (he basically designed it) since 1978 or thereabouts. And I don’t recall Herzlinger mentioning that in the numerous times she’s been slamming managed competition and its father.

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  1. Maybe the most disappointing thing about Regina Herzlinger’s Atlantic blog piece is that she refuses to admit that she has totally misunderstood the Swiss health care system — even after Maggie Mehar explained in detail where she was wrong!
    Far from being “consumer-driven,” the Swiss system involves government control at almost every step: hospital budgeting, provider payments, and premiums.
    There’s much to be said for the Swiss system (and the somewhat less tightly controlled Dutch version), but misrepresenting it (even to Republicans) is unlikely to help solve the US’ woes.

  2. My mistake. I thought she was so keen on the Toronto Shouldice institute that she was advocating for a Canadian-style system.
    More to the point there’s nothing about a full system reform in either of her first 2 books (I must admit I bailed on reading #3). And she spends her entire time attacking moderate Dems who like the Enthoven moel (inclufing him of course) and anyone to their left.
    But if you really think she’s been really advocating Switzerland all along (rather than just sniffing the wind), then I’m sure there’s a Medicaid HMO or two with a board seat coming open soon….

  3. Actually, Regi has been in favor of the Swiss system for many years. As for regulation, back in the late 1990s, when she was still writing policy papers for the moderate Democrats at the Progressive Policy Institute (PPI) — as was I — Regi advocated the equivalent of a health insurance Securities and Exchange Commission. In a PPI paper entitled, “Protection of the Health Care Consumer,” she advocated a regulatory agency that would cause the markets to:
    *Disclose complete and reliable information.
    *Contain fair prices for health insurance policies in the sense that they reflect all publicly available information.
    *Protect consumers with information that helps them to redirect money from ineffective insurers that provide too little medical care for their price to insurers that give customers the quality and price they want.
    *Lower the transaction costs of buying health insurance.
    (For the complete paper, see: http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=111&subsecID=138&contentID=1344)
    Regi still advocates that type of agency in her speeches and writings, albeit wrapped around a much more conservative outlook than most moderate Democrats could stomach. Alas, it’s been many years since anyone cared what we moderate Democrats thought, but perhaps we’re due for a resurgence.

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