This one got a little too heated, myself included. Still, I thought we had a good discussion generally.
I opened by saying that the impact of HC reform is pretty speculative at this point. The big winners in the short term will be the currently uninsured and underinsured (as much as 15% + 15% of the population—but probably not really that high) , and people who have to survive in the overpriced individual health insurance market (another 5%). I think the major HC industry players (big Pharma, insurers, hospitals, etc.) will gain, not lose, at least for a while. Hey, they’re gaining 30 million new customers who will be mandated to buy their products; plus Obama cut explicit deals with them to protect their short-run profits. That’s why the big boys are not openly opposing him, and why so many liberals are angry.
To my surprise, the discussion focused on the Democrats’ alleged ulterior motices and Republicans’ alleged alternatives, rather than on who would gain or lose under what’s likely to become law. Still, Elane and Chris were right on, I thought, to be skeptical that we could get a lot of pain-free savings out of Medicare. I countered, though, that other, bigger pots of money have been placed off limits by the political process, so they have little choice but to trim Medicare if the public insists that this whole thing be budget-neutral. The trick will be getting those cuts out of doctors and hospitals, rather than their patients.
As I said, the biggest by far of these pots is the tax exclusion for employer-provided HC insurance. As Fred said, our whole employer-based HC system is kind of an accident of the WWII-era tax code. Here are 2 short explanations of how that all works:
Also, here is a caustic but accurate summary of GOP alternatyive “ideas,” using their own words from an LA Times article.
Lastly, here’s a PBS quickie guide on HC systems in 5 other countries: