Sunday, January 16, 2011

Outline of Health Compromise (@kevinmd on twitter) posted my suggestion from mid-December for what a compromise health plan could look like. It will be interesting to see what House Republicans do in the way of developing a 'replace' or 'modify' bill(s).


  1. Maybe the Democrats need more time to read that we passed it like Pelosi suggested we needed to do so we would know what was in it?:). I read your article at Kevin's, but I hope other posters are more fortunate than me. My posts were deleted....and.....yes...they were nice,:)

    I am thinking about your post...some good objectives....but some of your wording seems unobjective. I thought you did a good job...but....the wording and intent in a few places left me with more questions. I wish I had saved my posts.

    Thinking......repeal...or compromise...hmmm.....

  2. Not sure if I should post this here or under the origina post. I will Kevin's another try too:

    In reviewing your article it is a nice overview, but it raises many more questions.  You do seem a bit partisan, so I will share that I, too, try to be objective but it's very hard not to view something as important as this without bringing our own personal ideologies to the table.  

    You share that the ACA does pretty well on the lack of coverage, then propose to replace the individual mandate to purchase insurance with a type of bait and switch approach to catastrophic coverage.  This is really not pragmatic at this time when the whole issue may be going before the Supreme Court.  To say both sides need on board...while we have a highly possible Supreme Court battle with the justices leaning liberally means the whole issue is a bit dormant at this time until we figure out if Congress even has the right to mandate any type of insurance on the common man.

    You share the conservatives are endorsing a "new federal apparatus".  We are?  I thought true conservatives had more libertarian leanings and want to go to a state type of apparatus?  If your proposal about individuals paying instead of employers was played out the Cadillac plans will phase out from a huge segment of society, and tax revenue will go down as the worth of the policies goes down. We have Cadillac plans via our employers.  What does this mean to union contracts?  On the surface it would seem that your suggestion has repercussions to the average patient and a consequence would be we will have to pay for office visits...which keep us home more with problems that could be caught early?

    What do you think about a public option?

    You berate the Republicans for not jumping on the opportunity Scott Brown supposedly opened up with his election.  I thought Scott Brown was a liberal minded lawyer with a Republican label?  That certainly won't help with torte reform.  

    Overall.....unless I am completely lacking in understanding your intent you seem to be advocating more government....that's a real mistake if it is so.

  3. Lots of questions; most of them are answered in the 29 columns I wrote for the Raleigh News and Observer that are linked to the side. One of the links in the post is to an op-ed by Martin Feldstein, a well known conservative proposing a federal catastrophic insurance plan. Here is the link from my post
    A compromise along lines I noted would render the question of individual mandate moot, because you wouldn't need one.

  4. But if it's going to the Supreme Court (which seems highly probable) that will make your suggestion moot?

    I lack time to read through 29 columns. Is this your summation of them, or are they required reading to understand your stance? That seems like a lot of reading, but then again the bill is ridiculously long.

  5. No. If you adopted what I say (Medicare catastrophic cover with high deductible) you drop the individual mandate to buy insurance. If people want to only have catastrophic then that is fine. If they don't want to claim for the costs above the catastrophic amount that is fine. The post I wrote is my summary of how we could try and move ahead. The oct 30 column directly addresses my views of the public option as debated, and the June 7 gives an overview of how I understand health policy (two laws: everyone dies, and before that the healthy subsidize the sick). The essence of health policy is working out HOW #2 is done.

  6. But adoption of Medicare in any form could basically takes us into a type of public option and more government. And if anything is mandated on a level whether it be catastrophic or cadillac it may very well be an unconstitutional abuse of the powers that are given to Congress. But, I imagine, a liberal judge will try to overrule the Constitution.

    Thanks for making my work lighter by directing me to specific articles, but...I have major problems with the government running health care. I will admit to not being objective because I lived in the UK.

  7. Oh yes.....I really don't want to discuss cake reform!:) I have an iPad and I think it has a mind of it's own that is, obviously, working against me.

  8. There is no way to get universal coverage without some type of mandate. Of course, people are welcome to be against universal coverage. Medicare is a type of mandate as you say--you have to pay payroll taxes and later you get coverage. I don't believe the ability of the govt to collect a tax is in question from a constitutional standpoint. From a policy standpoint it may not be your preference, but those are different things. In any event, the ball is now in the court of the House Republicans...they have a chance to lay out what they think is the best way forward. It will be interesting to see what they do.

  9. Jennifer reading The Washington Examiner today. A few snippets I liked:

    Well, not with the new healthcare law, as Avik Roy nimbly points out in his point-by-point takedown of the DNC's pro-Obamacare talking points. Rather than a heavily regulated, heavily subsidized corporatist healthcare reform bill that takes many of the worst aspects of the status quo and entrenches them further, what American healthcare needs is free market reforms that put more choice into consumers' hands while lowering government involvement in the industry across the board.

    Government can still be a part of the solution - indeed, government will need to be a part of the solution, if only to repeal decades of bad healthcare legislation.

    Low-income insurance vouchers or catastrophic insurance vouchers could empower low-income Americans to purchase their insurance on the market. Meanwhile, forcing insurers to compete across state lines - and reforming the insurance regulations to apply to the state of the insurance carrier rather than insurer - could drive competition and lower cost across the board.

    Obamacare represents a failure of imagination - and while I was genuinely torn during the debate over reform between, on the one hand, my awareness that our current system is horribly broken and that a lot of people are unfairly left out in the cold, and on the other hand my dislike for what has ended up becoming a huge, expensive subsidy for insurers, drug companies, and the middle class - I think I can firmly say that the new law is a mistake. It may be a mistake that really does benefit a number of Americans, but a mistake nonetheless, and one that will end up costing the American taxpayer a hell of a lot more than the very conservative - one might say absurdly conservative - cost estimates put out by the CBO. And there's no way Republicans will be able to repeal it in time.

  10. I do not know who Jennifer is...iPad identity, I guess.....I really do not like the healthcare legislation, or the iPad. It's a conspiracy:)

  11. I would agree the Republicans could go down in flames over this, but if we are a democracy it seems the majority of people want it repealed (and, I agree, the government can collect a tax.....can and should.....and what leads to the well being of man and what is a right are in question). Shouldn't our representatives listen to the will of the common man?

    I don't like the government as a competitor in the free market. We already have insurance companies competing and the government makes an unfair playing field. They have far too much control and money. Doesn't the private sector already have a hand in helping with drug coverage, etc. There are so many problems with Medicare I am surprised when someone recommends more of the expensive same ole' same ole'. It just seems more like health control, than health care.

    Medicare and Medicaid are messy propositions and programs. Doesn't Medicare already have a high rate of refusals? Up to 50% of denials at times...much more than the highly regulated private sector. There is no security in this proposal.

    I live near Cleveland Clinic and I thought I read a proposal about putting the poor on Kaiser? It was about a tenth of the cost of the current law. Why isn't that proposal on the table? To let us have our private insurance and give others who show not just the inability to pay for insurance (because we know nearly ten million can afford it but because of mandates for all sorts of items insurance is costly...way too costly...which is why I think the government needs to tame down the mandates).

  12. They (republicans) need to write a bill and be clear about what they want to do. Easy to be against something, lots harder to be for something in health policy.

  13. I agree...and appreciate your transparency!