| 1. What role or roles should government play in paying for healthcare?
a. None
b. Source of information about providers and options
c. Regulator of providers
d. One provider of many for insurance (Medicare option for anyone)
e. The only provider of insurance (single payer, "Canadian healthcare", "Medicare for all")
f. Overseer of the healthcare delivery system (socialized medicine)
--> Currently, our healthcare system is a mixture of (b), (c), and (d).
--> Canada is (e), Britain is (f)
2. How should prices be set?
a. Whatever level the providers choose ("the market")
b. Negotiations between insurance companies and providers
c. Government guidelines
--> US is a combination of a and b
--> Canada and most other industrialized Western nations are a combination of (b) and (c); that's a large reason for the fact that healthcare spending in those nations is only about two-thirds spending in the US.
3. What goals should government set and implement regulations or plans to meet?
a. None
b. Reduce cost: cap the total amount spent and refuse procedures so that the cap is not exceeded ("rationing")
c. Reduce cost: remove access to unproven medical procedures (often, but incorrectly, referred to as "rationing")
d. Improved access: through regulation of prior condition denial and some unspecified way of reducing insurance costs
e. Universal coverage: by requiring a mandate, elimination of prior condition denials, and subsidies of low income individuals
f. Universal coverage: by acting as the single payer or healthcare system overseer
--> Right now, most of the health plans under discussion focus on (d) or (e); some also include (c)
--> Despite a promise by Nancy Pelosi to bring single payer to the floor, it's hard to believe that (f) is being taken seriously; I suspect this is a gesture only and that either the Blue Dogs won't let it pass or else the Senate will kill it
--> Public polling shows a majority of Americans agreeing with (e) or (f)
4. How should any subsidy of low income individuals be paid for?
a. There should be no subsidies
b. The smallest amount of subsidies should be grudgingly provided and as much as possible should be offloaded to states and local governments (roughly speaking, the current Medicaid approach)
c. Health care benefits should be taxed
d. FICA cap should be removed
e. Subsidies should be "on-budget"-- i.e., paid for out of the general taxes the federal government collects
f. Highest earners should have a surtax earmarked to "pay for the cost of reforming healthcare"
g. The federal government should pay for all healthcare in the US
--> We're currently at (b), give or take.
--> Canada and Britain and most industrialized countries are some mix of (d), (e), and (g), I think
Definitions:
Obamacare: used by groups who wish to see no change to denigrate any change. A false term, by definition, because the President has yet (to my chagrin) to endorse ANY bill.
Socialized medicine: The British system. But used inaccurately to refer to the Canadian system or any changes to the current system. Also, the Veteran's Administration health system.
Single Payer: The Canadian system. Require everyone to receive their health insurance from Medicare.
Rationing: Refuse reasonable care to reign in costs. Often incorrectly used to refer to the refusal of care that has not been proven valuable. The latter is more correctly termed "outcome based medicine".
Free market: a mechanism to allow decisions to be made one-at-a-time by the individuals: consumer (patients, their families) and providers (physicians, pharmaceutical companies, hospitals, device manufacturers) involved. As Krugman shows, it doesn't work for healthcare.
To have a market, the consumer needs to know enough to make decisions (do you have a medical degree? have you performed a residency in the field in which you are sick? absent that, you don't know enough, no matter how much time you spend on the internet), the consumer must have the option to shop around (how often does a car accident victim have the opportunity to choose an ER? does a heart attack victim get to choose the hospital where the angiogram happens?), there must be multiple equivalent options with providers competing (principally) on price and quality (patents and other protections effectively eliminate this).
So although many claim "let the market run healthcare", it doesn't, can't, and won't.
Resources:
Kaiser healthcare comparison tool: http://www.kff.org/healthrefor...
Recent Time article, focusing on the President's involvement: http://www.time.com/time/polit...
The President's principles on healthcare. Note this isn't a plan, so it isn't "Obamacare": http://www.whitehouse.gov/issu...
Krugman on markets and healthcare: http://krugman.blogs.nytimes.c...
Progressive retorts to health care talking points: http://www.dailykos.com/story/...
Where do I stand?
I would prefer a Canadian style single payer system.
I don't think that's likely to happen in the US any time soon.
I think there is a good compromise to be had and I've outlined it previously in these pages.
In short, it makes Medicare optional for all, subsidizes low income individuals, and pays for it through some tax adjustments. |
