Feeds:
Posts
Comments

Archive for August, 2009

Health Care 2.0

Hillary Clinton snatched defeat from the jaws of victory in her bungled attempt to reform heath care by over-reaching what was politically possible. She failed to take advantage of the enormous momentum she achieved. Conservatives were falling all over each other to enact a major insurance reform, lest their failure to accept meaningful reform would be their undoing. She should have taken the deal.

This time around the battle is shaping up rather much the same, with a difference. There’s a pragmatist at the helm who should not let his avant-garde control the outcome. Look for a climb-down from the White House to accept a needed restructuring of private insurance, handing business and a smattering of Republicans a compromise that looks a lot better than what they’ll get if the dig in for a fight.

Here are the necessary elements:

  1. Non-Discrimination requirement, that is, like grocery stores, taxi services, or phone companies, insurers should be obligated offer each and every health plan to anyone who will take it, at the same price to all for that particular plan, regardless of such factors as pre-existing conditions, age, race, gender, genetic markers, etc;
  2. Mandatory Minimum Insurance requirement, that is, each citizen should be required to carry a health plan that meets certain minimum requirements, such as covering medical emergencies;
  3. Free Market requirement, that is, employers may continue to offer a short menu of health plans as they do now, but each employee should have the right to take any competitive health plan they want, with the employer contribution redirected for that purpose, and the employee capturing 100% of the savings or paying 100% of the extra cost;
  4. Subsidy for poor people to help them pay for mandatory minimum health insurance. It may be necessary to create an “assigned risk” pool and a government-set premium for the minimum insurance, or a public plan to provide the mandatory minimum insurance where necessary.

Items 1 and 2 combine to prevent adverse selection on either side, and prevent individuals from externalizing their health risk to others. Item 3 enables consumer choice market forces to drive prices down and quality up in a way that the current employer choice scheme cannot. Item 4 is not that different from the “free” care poor people get now at the emergency room, so the cost to the public would be the same or better, and more controllable.

These are the necessary minimums. Democrats would be well advised to take this much now while Republicans are on the ropes, and Republicans would be well advised to do what it takes to prevent the inevitable loss of business support and ultimate socialization of the system if they fail to accept solid, meaningful reform.

Advertisements

Read Full Post »