Matthew Holt

Senate passes bill, more to come

It’s Christmas Eve and the Senate just passed a major health reform bill. Personally I think the reforms in it are relatively minor, but the passage of the bill itself is a screaming big deal. When I say minor, what I mean is that we’re leaving in place the inefficient employment-based health benefits system, and we’re expanding insurance mostly by putting more people into the separate but equal Medicaid program.

But this bill is a statement, and an important one.

For the first time we’re acknowledging that everyone ought to have health insurance and that those unable to afford it should be subsidized by the government. We’re also saying that insurance companies should take all comers at a consistent price without respect to health condition (and hopefully we’re implying that their job is to manage care not risk-select). Finally we’re saying that the majority of the cost can be paid for by redirecting inefficient spending within the health care system, and by taxing benefits that are only tax-free because of historical accident.

Building on those principles it may be possible to get us to a more equitable and more efficient health care system.

So whether or not you were like me (on balance) in favor of reform, anyone interested in health care should savor the moment. But realize that both after the conference (which will likely end up looking very like the Senate’s version) and the bill’s signing early next year, there’s still a long long way to go in the reform”.

For more takes on the moment see Ezra Klein in the WaPo, Jonathan Cohn in The Treatment and Jonathan Chait in The New Republic.

And for some more fun, Ezra Klein asked a bunch of health care wonks to comment on what they’d like to see added in the Senate/House Conference. I was one of them. (I asked for 1. Freeing Health data, and 2. Making Insurers Responsible for Health outcomes) but you can see links to virtually everyone who commented at the bottom of the last and shortest of the dozen or so letters to Santa which Ezra got.

Livongo’s Post Ad Banner 728*90

14
Leave a Reply

14 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
11 Comment authors
personal care home in CASean TeareJosef MayrGary LampmanKern Vore Recent comment authors
newest oldest most voted
personal care home in CA
Guest

Your blog is awe-inspiring. I have found many new things. Your way of staging is also fascinating. You have elected very incredible topic. I appreciated it.

Sean Teare
Guest

The current bill does little to improve public health. Until we encourage people to live healthier lives, through a carrot or a stick, we are not going to reduce the cost of health care. Providing universal coverage does not drive down costs. Just look at Massachusetts, my home state.
Sean Teare
Aprexis Health Solutions
http://www.aprexis.com

MD as HELL
Guest
MD as HELL

Harry Reid has made Rod Blagojevich look like a Sunday School teacher.

Josef Mayr
Guest
Josef Mayr

While the bill, whatever it may entail in detail, may be a marvelous work of litigation, it does not address the problem of health care, at all. It merely drives business to insurance companies and pharmaceutical corporations, and probably tax dollars to the government.
A REAL solution to the health care problem is as simple as allowing doctors to adhere to the provisions of the Hippocratic Oath, rather than binding them by corporate contracts.

Carlo
Guest

“Build more medical colleges on a masive scale. Prohibit medical litigation.”
What about the fact that certain treatments for conditions such as cancer can bankrupt a person with health insurance? I agree with you Kern but in addition why do certain supplements when bought in a drug store would cost less than if sold to a hospital from a supplier, such as bandage wrap? The markup is ridiculous.

Gary Lampman
Guest
Gary Lampman

Real world Pricing that reflects the actual cost of a Operation. The problem I see is the fact that the agreement is between the Insurer and the Provider. So who represents the Patients Interests? Neither of these organizations! So how is the patient to demand price Justifications,when neither party is accountable to the patient?Rather, You are held accountable to the Health Insurer and the Provider. So, who do you think are the targets of this exploitive scam? Yes! It is you and I. Neither of us have any control over the pre-arranged agreements that your states Insurance and Commerce, Departments… Read more »

Kern Vore
Guest

The problem with the presidents approach to health care is that he does not recognize the real problem. The exorbitant cost of training health care workers is outrageous! We need to focus on the real issue. Expanding medical training and making it affordable at the root level. Health care workers should graduate with no student debt, period. We need to start the training at the grade school level, progressing on from there. Once the supply of healthcare workers has met or exceeded the levels needed, people can get the care they need at very affordable rates. There is no reason… Read more »

MD as HELL
Guest
MD as HELL

May the guardians of our Constitution save us from this ugly disaster.

Rae
Guest
Rae

I agree with Game.The U.S itself has complicated the health system.As President Obama said-There is a lot of “waste” in the system. This is the major cause of the high costs. Cutting the waste will not be easy as it will affect many people’s lives.U.S should definitely learn from other developing countries to reduce the costs.

archon41
Guest
archon41

And is it supposed that insurers will absorb the costs of insuring the seriously ill from their vast stores of wealth, or that they will simply raise premiums for everyone? Or have we not got that far in our thinking?

Skeptic
Guest
Skeptic

I urge everybody to read Richard Epstein’s critique of the health care reform bill at medicalprogresstoday.com. You don’t have to accept his legal arguments to be very concerned about the potentially adverse economic impact of this legislation.

Carlo
Guest

This is a minor step, but I believe it is a step in the right direction. Whether or not you agree with the reform bill, one thing that is certain is that our current medical model is not as effective as it could be. Also, it will be years before we see the results from positive change due to training needs of licensed professionals and reorganizing the current structure of insurance companies.

Game
Guest
Game

I think we have over complicated the medical system in US. People in India / China spend 1 / 10 of what we do on health care yet their service is 80% as good as ours. What we do need is introduce competition in this field. Get more doctors / nurses from overseas, breed more doctor and nurses from US universities, re-evaluate all the red tape that is keeping our cost so high.

Ron
Guest
Ron

“For the first time we’re acknowledging that everyone ought to have health insurance and that those unable to afford it should be subsidized by the government. We’re also saying that insurance companies should take all comers at a consistent price without respect to health condition (and hopefully we’re implying that their job is to manage care not risk-select).” I’m not really disagreeing with anything in your post except for the fact that if insurance companies can no longer risk-select, as you put it, its now not insurance. We are simply managing health care rather than insuring something. Insurance is the… Read more »