Edwards' health care proposal
I'm not sure whether I'm just dense, but I'm having difficulty wrapping my mind around the details of John Edwards' health care plan (pdf). Ezra Klein thinks it's pretty good, but I'm still scratching my head about it.
First, it retains employer-based insurance for those employers who choose to insure their employees. Those who don't will be forced to pay premiums to "regional health care markets" where their employees and others can get insurance (more on the regional markets in a minute). Why retain the employer-based insurance? It makes no sense to me. To the extent employers stick with their own plans, their employees will be forced to stay in that plan, like it or not, just as many are now. When the employer changes plans, the employee would have to follow, even if his/her doctors were no longer in the new plan. I'm not sure, but I believe the employer-based plan could still be group rated, so, if a Wall-mart decided only to hire workers under 40 years of age (as they now seem to be doing) their plan could get a group rating with low premiums, and they would be able to game the system.
The proposed "regional health care markets" include both private insurance and a Medicare-type government plan. Anyone could purchase insurance through the "regional markets" and all insurers would have to insure all comers, regardless of pre-existing conditions, age, sex, race, etc. It's not clear whether all would be insured at the same price, since the plan simply calls for a "fair" price, whatever that is. I would hope the plan would require all to be insured at the same price. So far, so good, but why should these markets be "regional?" Do they contemplate different costs in different regions? If so, why? How large (or small) are the regions to be? It just seems to me that this would add a layer of complexity that is unnecessary. It also might lead to other ways of gaming the system.
Under Edwards' plan, all residents would be required to be insured (either through their employers or on their own). Tax credits, expanded Medicaid and other inducements would be offered to help ease the burden. He thinks there will also be some savings since insurers won't have to advertise (why not?), and underwriting costs will be lower.
It strikes me that these savings are likely to be small relative to those that could be achieved by a single payer system.
Edwards' also says there will be savings because the regional market will be able to negotiate better deals with the insurers. Frankly, I don't get this at all. A "market" doesn't negotiate. So, I'm confused.
All in all, this seems to me to be a very complicated system. There's no doubt it would be somewhat better than what we now have, but why all the complications? Perhaps, Edwards sees this as the only politically feasible way to get the ball rolling, but somehow, I doubt this will face any less resistance from the insurance industry than any other plan. They're going to fight tooth and nail no matter what.
First, it retains employer-based insurance for those employers who choose to insure their employees. Those who don't will be forced to pay premiums to "regional health care markets" where their employees and others can get insurance (more on the regional markets in a minute). Why retain the employer-based insurance? It makes no sense to me. To the extent employers stick with their own plans, their employees will be forced to stay in that plan, like it or not, just as many are now. When the employer changes plans, the employee would have to follow, even if his/her doctors were no longer in the new plan. I'm not sure, but I believe the employer-based plan could still be group rated, so, if a Wall-mart decided only to hire workers under 40 years of age (as they now seem to be doing) their plan could get a group rating with low premiums, and they would be able to game the system.
The proposed "regional health care markets" include both private insurance and a Medicare-type government plan. Anyone could purchase insurance through the "regional markets" and all insurers would have to insure all comers, regardless of pre-existing conditions, age, sex, race, etc. It's not clear whether all would be insured at the same price, since the plan simply calls for a "fair" price, whatever that is. I would hope the plan would require all to be insured at the same price. So far, so good, but why should these markets be "regional?" Do they contemplate different costs in different regions? If so, why? How large (or small) are the regions to be? It just seems to me that this would add a layer of complexity that is unnecessary. It also might lead to other ways of gaming the system.
Under Edwards' plan, all residents would be required to be insured (either through their employers or on their own). Tax credits, expanded Medicaid and other inducements would be offered to help ease the burden. He thinks there will also be some savings since insurers won't have to advertise (why not?), and underwriting costs will be lower.
It strikes me that these savings are likely to be small relative to those that could be achieved by a single payer system.
Edwards' also says there will be savings because the regional market will be able to negotiate better deals with the insurers. Frankly, I don't get this at all. A "market" doesn't negotiate. So, I'm confused.
All in all, this seems to me to be a very complicated system. There's no doubt it would be somewhat better than what we now have, but why all the complications? Perhaps, Edwards sees this as the only politically feasible way to get the ball rolling, but somehow, I doubt this will face any less resistance from the insurance industry than any other plan. They're going to fight tooth and nail no matter what.
posted by walldon | 2:38 PM
1 Comments:
It needs to be a plan that one can describe -- not all the details, but a basic understanding -- in just a few words. "Medicare for everyone" meets that test. But I don't think Democrats probably should be proposing "plans" at this point, because they will just get picked apart. An absolute commitment to get the best ideas and a simple plan that everyone can support within the first year, for example, with the declaration that you expect to be held accountable for accomplishing that, should do the political job for now. Especially if the fundamental principles are stated: must covers everyone, must prevent financial disaster from a health crisis of you or your family, you can never, ever lose it (absolute portability). In my mind, the right concept is simple Federal umbrella insurance, starting with a deductibility level that we as a nation can afford (considering the huge cost reduction this will make in existing plans -- employer or private -- by putting a ceiling on liability). After we get our feet wet with experience, we can start the continuing debate on how far down we as a nation want to bring the deductibility level -- i.e., how protective we want the Federal umbrella to be. We can try to devise fair ways of gearing the deductibility level to ability to pay, without making too much bureaucracy in the process.
Post a Comment
<< Home