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Tuesday, October 10th 2006

It Is Near Halloween…

…so a scary thought.


Not Quite As Scary As Mark Foley…
But Still A Good Halloween Costume

I’ve posted several times (for example, here and here) on what course health care policy might take after November. And as MyDD concludes there is a good chance the Democrats will take back the House and quite possibly the Senate.

Slate has an op/ed up on what health care might look like if that comes. Or more appropriately what the author thinks it should look like.

There’s much to be said for a single-payer system. Countries that have taken this route spend much less to provide secure insurance to everyone than the United States does to provide incomplete and insecure coverage to less than 85 percent of the population. Yet these advantages—guaranteed coverage and effective cost control—could be achieved without going all the way to a single national program, with all the public skepticism and political opposition that such a program would surely engender. Yes, Americans like Medicare, and yes, Medicare is easy to explain. But that doesn’t mean most people are ready to say everyone should be covered by Medicare. Many of us remain stubbornly attached to employment-based health insurance, and proposing to abolish it entirely is likely to stir up fear as well as gratitude.

So, why not give employers the option of providing low-cost coverage to their workers through a new public program modeled after Medicare? If employers want to provide comparable private coverage, they can. But if they don’t provide basic insurance, their workers should be automatically enrolled in the new Medicare-like program.

His basic plan boils down to government “subsidy” of insurance costs by a massive expansion of Medicare, and an employer based mandate to provide the premiums for the “Plan B” premiums of their workers, or the premiums of comparable private insurance.

It isn’t clear if the unemployed and self-employed would have an individual mandate like the Massachusetts plan but they would be able to enroll in the extended Medicare with premiums set on income.

I have strong trouble believe a Levine Group estimate that under his plan half of country would still be insured by private insurance. Depending on the appropriations it may be very difficult for the private market to provide a comparable value to what Medicare does. There will always be a nitch high end market, but can the private insurance companies really wrestle away half of the population when you’re offered comparably cheap, decent government sponsored coverage?

Well that’s the entire argument of proponents of single payor. But what I’m saying is, even if it isn’t single payer in name, this plan offers to raise the exact same consequences.

Namely? Huge cuts in physician and hospital reimbursement as time passes (without any commercial pressure to keep them, considering most of the market is controlled by a single payor). A decline in health care access (as the government looks to control costs). A decline in physician quality and an increased reliance on foriegn medical professionals (secondary to decreased earning potential).

It also doesn’t solve many of health care’s current major problems. It shares the concerns raised by a single payer system with those of the current system. For instance, an even greater pressure for physician office’s to become assembly lines, where you see as many patients as possible in a day (as reimbursement drops).

I’m a pragmatist, and like the Mass. plan this one relies on both market and government forces. Albeit, it calls for a much greater government expansion of spending than Governor Romney did. It has a lot more people to try to cover (as a percentage) as well though. It may be as close to a “compromise” on health care reform the more libertarian minded can hope for.

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