Health Care Reform: Winners,Losers (Part 2) – This Weeks Meeting (9/17/9)

Health Care Reform-Winners,Losers (Part 2)

Here what my angle will be,
and what I think we should focus on initially.

Last week we talked mainly about the health insurance industry. As I said, this
makes sense, since most reform proposals are aimed at insurers because they are
the paying customers for most privately-funded health care. But, we never got
deeply into the rest of the HC industry: doctors, hospitals, Pharma, nursing
homes, clinics, scanning centers, etc. How will reform affect them? And, we
did not speculate much about the impact on HC consumers (you know, those
individuals that other countries call “people”).

So, in a blessedly short opening, I will briefly (1) break down who’s who in the
HC universe and then (2) ID the few obvious winners and losers if what’s on the
table passes. I’ll then outline how to think about who’ll get what benefits in
the longer term. Of course, future affects are hard to predict. I’ll also come
prepared to lay out some of the Democrats’ options for paying for all of this,
and answer basic questions on other major countries’ HC systems.

I look forward to our Death Panel!


2 responses

  1. I find the case for “urgent” action unconvincing, suggesting motives other than improving health care. One published proposal (HR3200) contains many provisions obnoxious to a free people. Who has a link to the President’s plan ? Baucus’s plan ?

    “…most of this plan can be paid for by finding savings within the existing health care system” said the President to a joint session of Congress. He added: “Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan.”

    If either statement is true, why not start finding savings immediately ? Some suggestions:

    1. Executive Order outlawing restrictions on selling policies across state lines.
    2. Allow people to create their own “groups” to spread risk.
    3. Hugely reduce the amount tort lawyers can earn from medical “malpractice”.
    4. Mandate a co-pay on every treatment, with substantial co-pays the more elective/not-life-threatening procedure is.
    5. Force hospitals to publish to internet a single cost for each treatment option and to identify realistic ways a patient in clinic A could obtain lower price treatment at clinic B (lots of hurdles)
    6. Publish results of Massachussetts (and Hawaii?)
    7. Set up a genuine review panel to engage the public in an honest discussion.

    I’m sure we could come up with 100 more suggestions. The active suppression of discussion on this topic has been amazing.

  2. Hawaii’s health care system insures over 95% of residents. Under the state’s plan, all businesses are required to provide employees who work more than twenty hours per week with health care. Heavy regulation of insurance companies helps keep the cost to employers down. In addition, due in part to the system’s emphasis on preventive care, Hawaiians require hospital treatment less frequently than their counterparts in the rest of the United States, while total health care expenses (measured as a percentage of state GDP) are substantially lower.

    Some critics have said that the premiums paid by Hawaiians (an average of $431 a month) has risen 3 times the rate of wage increases over the last decade. (Still a third less than my monthly health bill.) Also, the system mandates employers provide the insurance. Not much good when you’re too sick to work.

    Unlike Massachusetts, Hawaii doesn’t mandate the purchase of health insurance. Hawaii does manage a pool of regulated insurers, from which employers choose their plan. Like Massachusetts, Hawaii doesn’t specifically require that insurers provide health insurance to everyone. Pre-existing conditions can exclude people from coverage in Hawaii.

    Here’s a link to an interesting critique of the Hawaiian health care system, complete with a bit of history: Okay, it’s from the Heritage Foundation, but cross burning’s only bad for your health if you breathe in the fumes.

    What’s clear from the state experiments — Hawaii started their’s in 1974 — is that without meaningful cost control, health care systems will outpace GDP. These state plans have focused on the availability of coverage, while mostly ignoring cost containment. All health systems in the industrialized world ration care to rein in costs. Rationing is a dirty word here in the U.S., but health care is a limited resource. Get over it, America. None of the state systems and certainly none of the current federal proposals contain any hint of rationing.

    We can have it all, it seems, and for the lowest price. We don’t want socialized medicine, but we want the best medical care. We don’t want big government, but we want everyone (except the undocumented) to have access to care. We don’t want to pay to fix the system, but we’re willing to pay more for the system we’ve got as long as I don’t lose my health plan. Until we start to give a damn about our neighbors and even people we don’t know in our communities, I don’t think our culture is mature enough to debate any form of care system.

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