Simplicity of Solution II
First of all, let's stop calling health care reform by the wrong name. It is NOT health CARE, it is health INSURANCE. It is a mistake to call it anything else.
We are making it way to complicated. The solution is very simple, really. Medicare works very well. If the pool of insured became younger and more healthy, the costs of Medicare would drop proportionately. Finding the actual cost involved would require actuaries to figure out. Once done, allow people to buy into Medicare. Small business would jump into the pool. Self employed would jump right in. Make a sliding payment scale for anyone else and you have a very reasonable solution to a very painful problem.
So, what's all the hubbub, Bub?
We are making it way to complicated. The solution is very simple, really. Medicare works very well. If the pool of insured became younger and more healthy, the costs of Medicare would drop proportionately. Finding the actual cost involved would require actuaries to figure out. Once done, allow people to buy into Medicare. Small business would jump into the pool. Self employed would jump right in. Make a sliding payment scale for anyone else and you have a very reasonable solution to a very painful problem.
So, what's all the hubbub, Bub?
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That would never work! Because, um...because, um...well, Rush, DeMint, and Newt all said so.
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The only thing I would do differently is to mandate it, dropping the age of Medicare by 10 year increments over a short period of time, so as to make the transition manageable. The only way it can actually be affordable if there is shared risk -- young, old; sick and well; and the only way to do that is with mandated coverage.
July 26, 2009 10:45 AM | Reply | Permalink
This is an interesting, yet concise, perspective.
All righty then!!!
July 26, 2009 10:47 AM | Reply | Permalink
All right then, indeed!!! What's the hold up? Onward agnostic soldiers :)>
July 26, 2009 12:52 PM | Reply | Permalink
Accept, of course, that Medicare is unsustainable in its current form, negotiates rates that would be unsustainable if applied to the entire system and only picks up 80% of the tab. Take insurance companies out of the mix and health care providers wouldn't be able to give Medicare the same negotiated rates because there would be no one to pick up the true costs of the system.
I actually believe the real situation is exactly backwards - there are no simple solutions to such a complex problem. Health insurance, though important, is still only a single data point in a detailed equation of dysfunction that requires more holistic thinking to adequately address all the problems that will keep us from succeeding.
I understand the impulse for simplicity given the American people's apparent inability to understand nuance but that won't deliver the reforms we actually need.
July 27, 2009 9:41 AM | Reply | Permalink
Except, of course,I do not accept medicare would be unsustainable if the pool was enlarged by younger healthy people rather than aging Boomers. Get back to basics and understand that Health Insurance is simply a legal Ponzi scheme that requires more capital at the bottom, to maintain payouts at the top. Everyone that lives long enough will get health care in one form or another. That is how Americans are. We will eventually do the right thing, even if we have to be dragged kicking and screaming.
July 27, 2009 10:26 AM | Reply | Permalink
Whether you accept it or not is beside the point. Medicare has severe problems that can't be wished away by assuming a different risk pool would make it so.
Further, you don't address the problem that the only reason Medicare is able to exist as it does today is because medical providers give them a sweet deal on negotiated rates and make up for the delta by overcharging private insurers. Take private insurers out of the mix and all the math changes.
Like it or not, there are no simple solutions to this problem. A strong Medicare system as the public option makes a lot of sense for a number of reasons, but independent many other foundational reforms, Medicare alone is unlikely to lead to a sustainable system of health care in America.
July 27, 2009 10:56 AM | Reply | Permalink
Except it or accept it, the current system is untenable at this time. Medicare is the best option to get something going right now. We, as a nation, have been arguing about how to do this for forty plus years and seem no closer to a viable solution. So let's shift or get off the lot. The time is NOW to start and Medicare should just be the starting line. Let' get going. We are burning daylight.
Stay healthy my friend.
July 27, 2009 11:22 AM | Reply | Permalink
Except that Medicare isn't even considered in the current legislation at all. By the way, Medicare was supposed to be the starting line more than fifty years ago, yet that line hasn't budged except to cover prescription drugs now.
Accept it or except it, the plan being currently pursued in Congress does very little to fix the numerous problems in the health care system that have been leading toward its collapse. That being the case, hurrying up to pass faulty legislation should be the last thing are contemplating.
If we have been "arguing about how to do this for forty plus years" then I fail to see how a few more months to ensure we get it right is a bad thing.
July 27, 2009 12:27 PM | Reply | Permalink
You make some valid points, but miss the big picture. Any reform coming out of this mess will no doubt be next to useless, because the insurance industry has already co opted the process. The only way to get past this is to extend a program that has some success in operation.
I would love to hear your plan to get ALL Americans covered with enough insurance to make life easier and cheaper for everyone. Please keep it to two short paragraphs. Then we can talk again. Together we can fix this. Right?
Stay healthy my friend.
July 27, 2009 11:22 PM | Reply | Permalink
I'll take that challenge.
First, I would regulate the health insurance industry within an inch of its life. Non-negotiable items like no longer being able to exclude items previously understood to be covered, no preexisting conditions exclusions and mandatory use of a government managed medical IT system to streamline and standardize medical administration. The most likely outcome of the regulations would be currently non-profit plans surviving while strictly for-profit companies either went out of business or went non-profit.
Then for the "public option" I would combine all the existing public plans into one group and add the uninsured and small business populations from the current legislation. Medicare, Medicaid, VA Medical, TRICARE (military health care) and all federal government employees (including Congress and the president) would become one plan. The size of bargaining population (likely to be over a hundred million at launch) and utilization of existing public infrastructure would lead to enormous cost pressure. Kind of like having the publicly-owned equivalent of Kaiser Permanente with three times as many people and facilities scattered across all fifty states.
That is just off the top of my head, but such a solution would encounter less resistance because all those public plans are already enormously popular with republican and democratic voters alike as is the idea that insurance companies need to be reigned in and made to operate under strict guidelines.
Unfortunately, our fearless "leaders" in Congress are still treating this like a partisan fight when it should be a partnership to craft the best system we have. There are both conservative and liberal ideals that MUST make it into the final solution to be effective and sustainable.
July 28, 2009 8:20 AM | Reply | Permalink
With all of the insurance companies wrangling and paying off senate and congressional leaders with donations, do you really think mondo regulation is realistic? Big Pharma and all For Profit Insurance companies will spend enormous amounts of cash to kill this at any cost. Legal or underhanded or stealth or flat out illegal, this proposal would be ground to dust.
Paragraph two seems a lot more realistic. This is quite similar to my proposal.
Our ‘Fearless Leaders’ are trying to please all of their constituents and donors. They want to get reelected. They need us to start screaming at them very loud and very often. We need to pick a proposal and hammer at that one ONLY. The scattershot approach spells doom to any meaningful reform.
Stay healthy my friend
July 28, 2009 1:03 PM | Reply | Permalink