Government Run Health Care

It really does exist....but only for Congress.

Universal cover via private insurance

in the Netherlands is done with private insurance companies and an individual mandate. And lots of regulation. A good, short description.

Sen. Carper

is said to be shopping an amendement that would give states the option of adding a public plan in their state exchange. Would be full discretion for states to allow one, and to set up the policies (such as what rates to pay providers). New York could decide to have one, and Oklahoma wouldn't have to, etc.

Watching the Senate Finance Comittee it has been interesting to see Democratic Senators being open to other state choice elements.....like a state deciding to not have an individual mandate....if they can provide coverage levels similar to what an individual mandate would provide.

Interesting to watch the Dems round into states rights, competition and choice as the watch words for arguing for reform. The Republicans are left with 'government takeover of health care' but anyone watching the Senate Finance Committee has quickly realized there aren't so many crazy lefties on that committee....

Medicaid and the recession

Report showing Medicaid enrollment rose by even more than expected....enrollment always rises when the economy is bad....at same time it is hardest for states to pay for their share.

My spending is a benefit, yours is a cost

Good article summing up this notion, that is rampant in our culture. We all say we want health care spending increases to slow, just not our spending! And he is right on about how the tax on high value plans would work....the point is to pass the costs down to consumers of health care. I would still prefer tax exclusion of employer provided insurance, it more clearly links the issue of cost to individual behavior.

And this is a useful post, illustrating rate of cost increase in Medicare v. private insurance. Medicare is going to bankrupt us if we do nothing, but will do so slower than will private insurance.

Public Option defeated in Senate Finance Committee

This is not exactly a shocker, but two public option amendements to the Baucus bill were voted down today in the Senate finance committee. The amendments were offered by Rockefeller (the more expansive one) and Schumer (more pared back one). Sen Finance Committee more conservative than the Senate as a whole. If the House passes some sort of Public Option, then it could make its way back in a conference bill.

Baucus, Carper, Conrad, Lincoln and Nelson (of Florida) joined all Repubs in voting against Rockefeller amendment (15 no, 8 yes). Carper and Nelson voted yes on the Schumer amendement, which lost 13 to 10.

Next big issue is Ron Wyden's free choice amendment that should come up tomorrow....this would allow more americans to purchase private insurance via the exchanges (markets) to be set up if they want to do so.

The Dems are getting their feet in making arguments about giving people choice... Wyden Amendment and public option. A pretty good cultural symbol to invoke. And I think the Repubs overplayed their hand in August....once you have said Obama wants to kill your grandmother and then say 'well, not really, but you know what I mean' people probably stop paying attention to you as much.

The most interesting thing would be if Wyden Amendement passed....would the insurance industry revolt? Because as written, they (insurance industry) getting new customers that they now have little interest and/or ability to sign up (only 14 Million non group policies in US out of 307 Million people). But, if people with employer based can bail from that and go into the exchange and buy their own policy, this could be quite disruptive to employer market. Insurance won't like that. And if they did revolt over Wyden, would it be too late and transparent? Still, they have mighty big guns (and one of them is named Baucus).

Malpractice, defensive medicine and politics of reform

The News and Observer has a front page story today on medical malpractice and tort reform. Several points from my perspective. [note, I wrote about this in N and O on Aug 7, but the 'new and improved' online version appears to not link to past articles....trying to work this out]

*I think defensive medicine likely raises the cost of the health system by 1-3%. 5% would be $125 Billion per year (this year total spending will be around $2.5 Billion, the $2.1 B the article notes is last year). The biggest estimate I have seen is $168 B per year (Charles Krauthammer wrote $200 B per year in a column this past summer, but I think he was just rounding up; will dig it up later).

*The article shows that rates of suits have been dropping. Several lawyers have written me saying so based on stuff I have written in the past saying we needed tort reform, mostly as a political tool to bring the docs along (and to respond to their true obessession with getting sued, even if the rate of such is dropping).

*Even if the data show that we won't save much money from tort reform (I don't think we will), if ONE doctor gets up wearing white coat and says defensive medicine is key cost driver, most folks will put more credence in that than they will the testimony of 100 lawyers plus 100 health policy guys.

*So, we need tort reform to (1) get the docs to be able to focus on providing care; (2) ease the way into a patient safety system in which errors are looked into to learn from; (3) docs will use this as 'escape clause' for any cost saving efforts in the system.....they retort will be 'what about malpractice?'

*And given that it is apparently quite hard to sue anyway, we aren't losing much by way of a deterrent for errors and poor quality.

Again, if you think docs are money grubers only (I don't), then heavy tort reform will be the only way to call their bluff. If reform comes about and defensive medicine doesn't drop, it will be something else. And tort reform could be the lead into a real patient safety approach that will improve quality in a way that tort law hasn't been able to do.