Jacob Hacker & Roger Hickey on Edwards Health Care Plan
Yesterday, presidential hopeful John Edwards announced a health care plan titled, Universal Health Care Through Shared Responsibility.
The New Republic reports today that a core feature of the plan is "the essential idea behind another health care reform plan that has been quietly generating a great deal of enthusiasm among reformers--a plan composed by Yale University political scientist ... Jacob Hacker."
That plan is Health Care for America, which Campaign for America's Future has been promoting debate around.
Today, Jacob Hacker and CAF Co-Director Roger Hickey released statements praising the basic outline of the proposal. Hickey noted this will significantly move the debate, while Hacker laid out areas for Edwards and other candidates to strengthen.
Here's Roger Hickey:
The health care plan put forward by Sen. John Edwards this week moves the debate in a very constructive direction. We hope other candidates will address as comprehensively as Edwards has the changes necessary to make sure that everyone in America gets good health care coverage -- and what it will take to ensure that new system controls costs as well as Medicare and the VA system now does.
The public wants to hear bold solutions to what they perceive as a health care crisis, and most Americans want to hear health care plans that not only step up to the scale of the problem; they also want to hear solutions that are simple and understandable to be discussed it town halls and barber shops. On both counts, the Edwards health care plan is a big step forward.
And Jacob Hacker:
Those who believe in health security for all Americans should celebrate John Edwards's new plan. It includes two key building blocks for affordable universal coverage: a requirement that employers either cover their workers or make a reasonable contribution to the cost of coverage, and the creation of a new publicly overseen insurance pool through which workers without secure workplace coverage can have a choice of guaranteed public or private insurance, including an insurance plan modeled after the popular Medicare program.
To be sure, Edwards's proposal could be less complex and even more effective. I would prefer, for instance, a single national insurance pool for those without workplace coverage, and I believe the public Medicare-style option should be allowed to offer the broader benefits necessary to attract younger workers and compete on a level playing field with private insurance plans. If this were done, as Edwards himself has said, the system may evolve over time toward a Medicare-like approach -- the only approach that has been proven to control costs over time without shifting more costs and risks onto patients.
The Edwards proposal should be commended for creating a flexible framework for building on good employment-based coverage and the best elements of public insurance, rather than locking us into an individualized private model, as so many recent proposals have done. The challenge for those who believe in this basic approach is to press for an even better proposal -- one that more forthrightly expands Medicare-like coverage to those without workplace insurance so as to guarantee broad pooling of risks and better control over costs and quality.
Hopefully that's helpful background as we all size up what the candidates have to offer.
Bill Scher blogs for Campaign for America's Future
Am I the only one who thinks that a tax on business to finance health care is a political non-starter?
February 6, 2007 2:24 PM | Reply | Permalink
I tend to agree, but it's also not acceptable, in many quarters, to admit to the number of unfunded mandates and to the amount of cost shifting through managed care.
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Howard
*equal opportunity offense to both extremes*
February 6, 2007 3:45 PM | Reply | Permalink
The problem I have with the employer-provided healthcare (and it's reasonable contribution) is the same as the problem I have now. My employer offers health insurance coverage - but it's so expensive, I can't afford it. Their cheapest plan costs a third of my salary. They have shifted so much of the cost onto us, they might as well not even offer coverage. I had to go out and find my own coverage, and it is one of those high deductible, gambling with your health plans that are great if you never get sick or have an accident. We gambled and lost this year, by the way.
Why can't we just have a simple universal health care plan, everybody automatically enrolled, paid for with a progressive tax plan that hits every form of income (not just payroll)?
February 6, 2007 4:38 PM | Reply | Permalink
Realistically, a national plan has to be essentially complete enrollment, with a probable First Amendment exception for Christian Scientists and others who do not want conventional medical treatment.
Given the success of the Federal Employees Health Plan, which actually has many similarities to one of the buyer cooperatives of the Clinton Plan, I wouldn't rule out multipayor with the ability to buy additional coverage, or to self-pay for other treatment not covered. While I'm not completely opposed to single-payor, I think having a range of coverages, with caveats, has merit. For example, the Federal program has a group plan underwritten by a Catholic organization, which does not cover contraception or abortion.
The caveats include that premiums have to be based on population rather than experience basis, there can be no preexisting (or, worse, genetic) condition exclusions, and there needs to be a reasonable mechanism to appeal denial of coverage.
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Howard
*equal opportunity offense to both extremes*
February 6, 2007 4:52 PM | Reply | Permalink
Oh, and my plan doesn't pay for pregnancy, either.
I think the simplest plan would be the best one. Let insurance companies offer extra coverage, secondary insurance to cover deductible payments, or additional coverage, or whatever. But have everybody pay into a single plan in which everybody is automatically enrolled. This works, and we know how to make it work, and anything else that tries to preserve some vestige of the immoral for-profit health care industry should be trashed for what it is.
February 7, 2007 9:08 AM | Reply | Permalink
There are a lot of good things about Medicare, but also some problematic ones. Like the larger managed care companies, Medicare tends to get deep discounts, which sometimes result either in cost shifting to those without better buyers, or in health care providers refusing to accept Medicare patients.
As an example of what sounds good but is sometimes questionable in practice, Medicare reimburses hospitals not on the basis of actual supplies used and procedures done, but on a flat rate per disease called a Diagnosis Related Group (DRG). Everyone else reimburses on detailed schedules, Common Procedural Terminology (CPT) for procedures, equipment, tests, operations, etc., and National Stock Number (NSN) for drugs. [Commercial disclaimer here; I work on software for hospital workflow process improvement. Some capabilities were designed specifically to minimize cost for Medicare patients. I will be using a real example.]
DRGs also group together multiple diagnoses, rather than the more specific International Classification of Diseases (ICD) codes used for most purposes. Medicare's assumption is that flat rate will encourage efficiencies. Sometimes they are right or right most of the time (see below), and other times, the DRG reimbursement doesn't cover actual costs. Sometimes hospital "list" costs are higher than the actual cost of goods and services, but, for a complex case that doesn't meet the criteria for a change or addition of a DRG, the hospital really loses money on the Medicare patient. These losses get shifted to insured patients whose insurance doesn't have Medicare's market power, or, worst of all, to uninsured patients with assets, who pay a very inflated list.
Example of difference: list price, a few years ago, for the hospital part of my pacemaker installation was $24,000. I was covered by the then 2nd largest US benefits manager, and the hospital received, under their contract, a total of $1,800 in combined reimbursement and my copay.
In a number of hospitals with which I work, the most common DRG is congestive heart failure (CHF). Some of the treatments for severe CHF unquestionably should be done only in the ICU. My clients decided that treatment with two specific and potent intravenous drugs, if that was the only reason keeping the CHF patient in ICU, could be done on a well-staffed general nursing unit with telemetry. So, when these medications are prescribed with this diagnosis, we implemented a special paging system to alert the nurses when the medication starts or a patient already on the IV arrives on the ward, and then alerts for special surveillance on each shift. I honestly don't know if this winds up being adequate safety -- the hospitals think so -- or a reduction in safety in the interest of the much lower cost of even a telemetry ward compared to the ICU.
Have you examined consumer-driven health plans (as opposed to employer-driven), such as the Federal Employees Health Plan? Would you see that as an alternative to single payor, or, instead, as the way supplementary coverages are negotiated, on a bulk rate basis, with insurance companies?
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Howard
*equal opportunity offense to both extremes*
February 7, 2007 12:26 PM | Reply | Permalink
The problem I'm having is figuring out what value the health insurance industry adds to the equation.
Oh, wait a minute.
I just figured it out.
They provide the campaign contributions.
February 6, 2007 4:46 PM | Reply | Permalink
Edwards is offering yet another iteration of Hillary's plan that keeps the insurance companies happily raking in money, while people continue to experience ever rising health care/health insurance costs.
How many times does it have to be noted that all of the other industrialized countries in the world use a single payer plan with no insurance middle men raking off their take from the top? You can't argue that such a plan is impossible when it is being done everywhere else. Maybe one feature of a new health care proposal has to be outlawing private health insurance.
We seem to be anxious to try just about every other idea under the sun rather than accept the one idea that is proven to work. I'm not being bribed by insurance companies - am I missing out on the deal?
Hoppy in Sacramento
February 6, 2007 4:51 PM | Reply | Permalink
While, AFAIK, other industrialized countries have universal access with a safety net, not all countries, such as Germany and Japan, are single-payor. We have one large-scale demonstration, in the US, that a consumer-driven, rather than employer-driven, multi-payor plan works reasonably well, although there would have to be changes to take the FEHP to universal.
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Howard
*equal opportunity offense to both extremes*
February 6, 2007 5:40 PM | Reply | Permalink
Many countries actually have a hybrid system with both public and (very heavily regulated) private coverage. Pure single payor is not as common as you think.
February 7, 2007 7:08 PM | Reply | Permalink