Wednesday, July 29, 2009

Health Reform Decisions

As the small group of Senate negotiators move ahead on a compromise health reform bill, the time is drawing closer that President Obama will have to show his hand and be clearer about what the deal breakers are for him. The Public Option seems to be going, going, if not gone.

It has been interesting to try and explain the health reform process to the students here in China that I am teaching (this is what they have wanted to talk about during free time; in fact, I have been asked to change the syllabus and talk through the various reform options on Friday). In trying to explain where it seems that the nation is at with health reform I have been saying.
(1) Reform is no longer only about covering the uninsured; there is an increasing understandng the default option of doing nothing is not sustainable economically for our nation.
(2) We are stuck in a 'no mans land' whereby many American are wary of more government insurance, and they would prefer a private insurance approach. However, most of the bills are filled with provisions to overcome what 'private market forces' do. For example, everyone wants to ban pre-existing conditions. But, private insurance underwrites....certainly we don't want to ban such practices in car insurance (if you are a good driver). So, we are looking for an answer that is 'private' but that has so many regulations and 'helps' that it is not really private or free market at all.
(3) This is the last chance for 'private market' approaches to work....if we get some sort of indiviudal mandate with state based purchasing mechanisms if it doesn't work out, then single payer will be the only thing we can practically do.
(4)The real question is what will be done to do something about costs. I would certainly favor limiting the tax exclusion of employer provided insurance, and we need a commission to take a hard look at Medicare--not only payment rates--but coverage decisions. This body has to be insulated from Congress....the last thing we need is Congress micro-writing payment rates or coverage decisions.

Interesting times!

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