Maryland is considering a plan that would require residents to purchase health insurance. Very similar on the surface to the Massachusetts plan, but with a few key differences.  Via Balt Sun:

The plan would be a radical change from the current system of employers
choosing which health plans to offer to workers. It would set up an
insurance exchange where individuals could choose from any plans
offered by insurers and keep the same coverage when moving from job to
job.

The plan wouldn’t apply to large employers, but the cutoff on employer size hasn’t been set.Employers would pay much of the cost, with each employer setting a
dollar figure it would contribute toward the purchase. And the state
would provide a subsidy for lower-income workers.   

The Maryland Health plan doesn’t include any mandate on employers –
making it different from the Massachusetts law. But Cowdry said
"individual responsibility would put greater pressure on employers" to
"be in the game" by contributing to insurance coverage.

If the idea actually goes anywhere, Maryland would become the second state to embrace the idea of mandated coverage.  Given the amount of attention and credibility Romney has gained by taking credit for coming up with the idea, it seems inevitable that more states will launch similar experiments. So who will be next?  In California, Arnold’s office has been hinting that a major health care policy announcement of some kind is on the way. I wonder if they could be planning something along similar lines. — John Irvine

So I’m up at Spot-on asking if you really wanted to get to universal care and reward your base, what type of political moves would you have to make. In other words, What Would Dubya Do?

Comment back here if you like.

In the last week the Democrats must have gotten sick of being told that they are supposed to be moderates. The New York Times tells them that populism should trump ideology, the nut jobs on the right still think that they are the second coming of Lenin,
and the corporate-friendly Emmanuel faction is already starting the
fight with the Dean "net roots". Which is why I’m on the record as
saying that no radical health-care reform will happen in the balance of
this decade.

When you look at domestic issues, of course, health care is by
a mile the most important, and the party’s presumptive 2008
presidential candidate Sen. Hillary Rodham Clinton, has, shall we say, a history in the area.
But realistically all that will happen in the next two years is for
Congress to give the administration the right – but presumably not the
obligation – to directly negotiate with drug companies about Medicare
prescription drug pricing. There’s also the likelihood that Congress
will approve a reduction in the bonus profits currently offered to
private insurance plans by the 2003 Medicare Act. But it’s just as
likely that the drug pricing measure will be vetoed by President Bush,
although the cuts in Medicare private insurer reimbursement will likely
be part of a budget act which the President will probably sign. Continue

Ugly truth: no health insurance, no liver transplant.  Lose your health insurance in your 50s for a brief time period and your reward is death and bankruptcy. You cannot read this story without going “that’s not fair”. There may be a rational way to decide who gets a liver transplant, but this is not it.

And as more and more of these stories get out, the pressure for change will continue to bubble. (Hat-tip FierceHealthcare).

KFF has some new reports out. The first is a Comparison of Expenditures in Nongroup and Employer-Sponsored Insurance. Here’s what the press release says:

The first Snapshot examines the differences in costs associated with individual, nongroup insurance and employer-sponsored insurance. Premiums for nongroup health insurance available from online brokers or reported by insurance industry surveys are much lower than premiums observed for employer-sponsored coverage. This is surprising to some because nongroup health insurance has higher administrative costs. The paper uses data from the Medical Expenditure Panel Survey and finds that people covered by individual insurance have much lower health care spending on average than people who have employer-sponsored insurance, but pay a greater share of that spending out-of-pocket. It also shows that those with individual insurance are significantly more likely than those with employer-sponsored insurance to report that they are in excellent physical and mental health. These findings may help explain why premiums for individual coverage are actually lower than group coverage. The analysis suggests that proposals to extend coverage to lower income people through lower cost nongroup health insurance need to account for the higher out-of-pocket costs associated with these policies.

In other words when someone tells you that eHealthInsurance.com is selling a product cheaper  than employers buy it for (as the Galen folks and David Gratzer’s book have recently done), you need to understand that they’re not only selling something different (lower benefits) but that they’re refusing to sell it to people who might actually use it.

The second is a little more subtle. It’s about the ratio of sick people to healthy people in an insurance pool, and the impact on the pools overall cost (premiums). Again from the press release:

The second Snapshot examines the sensitivity of health insurance premiums to enrollment shifts by high cost enrollees – a process often referred to as adverse selection. The introduction of high-deductible, consumer directed health plans has raised concern about their potential to attract younger and healthier people away from more traditional insurance plans, which could increase the costs of those plans. The public discussions of this possibility are often phrased in rather extreme terms – for example, that consumer directed health plans attract primarily the young and healthy. The new report shows that extreme selection behavior is not needed to produce real premium differences between insurance pools, and that the shift of even a small percentage of high spenders from one risk pool to another can have a dramatic impact on average costs – and, therefore, premiums – in the pools

In other words, you only need to avoid a very few sick people to make your pool cost much less. This is something that Medicare Advantage plans (and the GAO) as well as those in the individually underwritten market have known for years. And it’s why the only rational policy outcome (note I said rational, not likely) is a single national pool.

CODA: This is too funny. The very next email into my inbox after the KFF one was the charlatans at Consumers for Health Care Choices (Greg Scandlen) promoting a dinner for Pat (loony) Rooney–the guy who founded Golden Rule and pushed HSAs, and basically is more responsible than anyone else for fracturing what was left of the nation’s insurance pool, and causing all the problems that KFF is explaining!