is a comment on the provisions of the Senate Finance Committee aka Baucus Bill. I suspect alot of the discussion will be about no public option v. public option. I would support public option but don't think it can pass the Senate. A more fruitful line of amedments would be to focus on actually increasing competition in the bill. In North Carolina and in some other states, it will be hard to get competition because we have one dominant insurer, Blue Cross and Blue Shield (96.8% of the individual market; 72.5% of the group market). However, opening up the exchanges to more persons, and even to larger employers might actually shake things up in the group purchase market, in addition to insuring more of the uninsured.
The status quo is bad. Costs are unsustainable. Health insurance premiums are rising 3-4 times faster than wages, and there is evidence this process is accelerating. Do nothing and the next 10 years of wage growth will likely be totally consumed by health insurance costs. And the baby boomers are coming to Medicare. There is nothing we can do about that, but we have got to slow the rate of cost inflation in the health care system. All of this money being spent and we still have Millions of uninsured persons and under-insured persons (and also over insured persons). And we aren't getting our money's worth from our high level of spending.
We could go with a goverment insurance approach of everyone having Medicare. I would prefer this, but it seems clear that a majority of folks don't want gov't insurance (until they turn 65, of course). Instead, we are saying we want market forces to reign in health care costs. OK. We can try that and it might even be able to work, but we have actually got to TRY IT.
The Baucus bill is a useful vehicle to move ahead. It sets up a reasonable structure for private insurance markets for the individual purchase market. The subsidies are likely too low for many between 133%-300% of poverty, especially if only the uninsured and those in small businesses are allowed in. And the CBO says that the provisions of the bill actually reduce the deficit by $49 Billion over the next 10 years. So, as it is amended, holding the fiscal line (meaning balance spending with cuts or new revenue) can lead to a responsible way forward.
So, what we need to do if we are going to go this (market) way, is to let more people into these health insurance markets.
The status quo is unsustainable. We have got to shake things up.