Summit Thoughts

After 1 hr 45 min, my thoughts.
*opening statements exhausting
*First somewhat real exchange was Obama and coburn on waste, fraud and abuse
*First, very real exchange was Ryan and the young Democrat from House and President on federal v. state regulation of insurance, what level of regulation, and that there is a relationship between premium, level of benefit (actuarial value) and out of pocket. When Ryan admitted his plan (Patients' Choice Act) and Roadmap has minimum standards for coverage, was a big moment and young Dem agreed their bill has a higher level and the Pres said this was a legitimate difference. That is the beginning of talking Turkey....good.

*Most surprising thing from first 1 hr 45 minutes is Republicans saying one in three dollars non prodcutive in system. Dems agree. This hurts the argument Republicans have been making about 'not cutting anything from Medicare' but Coburn says inefficient even more in Medicare. I am not sure about one in three but agree much unproductive....this actually argues FOR using Medicare to finance as it in theory can be done in way that doesn't hurt patients if 1 in 3 not useful.

11:56-Noon: President makes key point. High deductible plan basically losing my house insurance. Dem plan has expansive benefit package, what he defines as 'real insurance' by which he means way to finance care if sick. Pres is arguing Dems prefer expansive package....and Repubs framing on catastrophic. This is true and not fully owned by Republicans....for example, Patients Choice Act only has enough tax credit for catastrophic coverage.

Pres says legitimate philosophical difference here, which I agree with. And it is useful that they have talked about increase in small group premiums under senate....Pres hits on head price is higher because coverage more expansive. Repubs say higher price due to regulation. YES.

This is a choice/difference that deserves to be highlighted. I am very surprised no Republican hasn't brought up individual mandate. Add that in and they are talking about some key questions. For me, it would be great move ahead to have catastrophic cover for many more.

12:10. I wonder if adding a catastrophic level of cover based on age (say under 30) would be useful? If both sides are talking about letting parents cover their kids up to age 25 or 26 tha t is a sign that the system doesn't work. It makes no sense that a 25 year old would be expected to get health insurance from the job of their parent. Maybe take Patients' choice act notion of autoenroll and put everyone under 30 into very high deductible plan. Let them buy more if they want.....add something on prenatal and that would work pretty well.

12:15. What if you passed the following federal regulation. individual mandate. No pre-existing and no recission. And insurance must cover everything that is not experimental. Then define insurance tradeoffs only in terms of premium and out of pocket deductible.

12:17. Dr. Boustany talking up reinsurance.....that won't help if the underlying risk pool is bad. Biggest problem conceptually with many of the repub ideas is that they segment risk....put folks into smaller and smaller pools. Answer is bigger pools if you are going to cover everyone.

12:24 Rep. Miller makes point of high risk pools are attempts to make segmented risk work whereby the answer is put into larger pool.

12:50: Obama and Cantor and Biden: fundamental point. Cantor notes in a perfect world everyone would have care. He says get rid of pre-existing but not a mandate. This is fantasy. Biden pipes up and points this out. That if you are for ending pre-existing then only way to bring this about is through regulation (this is true). Cantor had been saying large philosophical differences but Biden usefully points out that both are talking regulation, Dems may want more but it is degree if you are for ending pre-existing.

Key question: individual mandate or not? Cantor notes in perfect world all would be covered but we can't afford it. Key to get this straight and decide. What flows naturally from Cantor's point is that if we don't cover everyone, do we insist providers give free care?