Here is a great analysis of the Senate Bill by Keith Hennessey, a conservative, I think, but nevertheless, we should know what's in the bill, and his blog is accurate, though opinions are slanted. So I'm putting it up here, because I am just out of gas when it comes to analyzing the details of another 2000 page tome!
AND what's worse, these bills HAVE NO WORKABLE TABLE OF CONTENTS! Yes, they have a list of provisions, but they don't tell you the page. That's just a little bit of Congressional humor. "We want to tell you how to run an industry, but we can't adopt technology modern enough to create a table of contents for legislative proposals."
Nov 6, 2009
Why the House Health Care Reform bill is fatally flawed
Confession: I still haven't read beyond the first 225 pages of the House bill. I got that far because I wanted to understand the structure of the Health Insurance Exchange (HIE), especially how the public option (PO) would work. In a previous post, I concluded it was good enough, but worrisome in the long run .
But, today Martin Feldstein, a noted Harvard economist (not my favorite, but way smarter than I) has an op-ed piece in the Washington Post (Obamacare's Nasty Surprise) that lays out clearly why the House bill will not work as presently structured.
The basic flaw is that the law requires health plans to enroll all comers, regardless of health risk, but it doesn't provide carrots/sticks to individuals or businesses that are strong enough to induce the young and healthy to enroll. So, premiums will go up, kicking off a cycle of adverse selection into the HIE by the sick or high risk and opt out by the healthy.
There are ways to fix this problem, but apparently they are not in the bill, or surely Feldstein would have mentioned them.
One solution would be to charge anyone who does not sign up (or have qualified coverage) within the first year of the program a "premium penalty" for the rest of their lives. That's what happens with Medicare Part B, and why even the healthiest 65 year old is willing to pay right away. For every year of delay after you reach 65, Medicare adds 10% to the Part B premium for the rest of your life.
Another solution would be to increase income tax penalties.
A third solution would be to increase subsidies.
I like first idea, though, because instead of being seen as a "tax," the penalty would be seen as just retribution for a young person trying to game the system by delaying enrollment until he/she encounters the inevitable need for health care.
BUT... so far as I know, this solution isn't in current health reform proposals. Why not? That's where Feldstein sees the invisible hand of the single-payer lobby. As the cost of insurance goes up and up, and as fewer and fewer people are insured, a single-payer system will be the only alternative.
Design a HIE market to fail and you'll end up with a single-payer system. So many of my dear friends, family members, and readers want this outcome that I am in despair. Why do we think that a government monopoly is any better than a phone company monopoly in the way it will treat us? Supporting a move toward public monopoly of payment for health care is to say we want health care to be run the way that public education is currently run. Good teachers underpaid; average income children underserved; rich children opting out.
That's the best I can do by way of diatribe right now.
Have a great day.
But, today Martin Feldstein, a noted Harvard economist (not my favorite, but way smarter than I) has an op-ed piece in the Washington Post (Obamacare's Nasty Surprise) that lays out clearly why the House bill will not work as presently structured.
The basic flaw is that the law requires health plans to enroll all comers, regardless of health risk, but it doesn't provide carrots/sticks to individuals or businesses that are strong enough to induce the young and healthy to enroll. So, premiums will go up, kicking off a cycle of adverse selection into the HIE by the sick or high risk and opt out by the healthy.
There are ways to fix this problem, but apparently they are not in the bill, or surely Feldstein would have mentioned them.
One solution would be to charge anyone who does not sign up (or have qualified coverage) within the first year of the program a "premium penalty" for the rest of their lives. That's what happens with Medicare Part B, and why even the healthiest 65 year old is willing to pay right away. For every year of delay after you reach 65, Medicare adds 10% to the Part B premium for the rest of your life.
Another solution would be to increase income tax penalties.
A third solution would be to increase subsidies.
I like first idea, though, because instead of being seen as a "tax," the penalty would be seen as just retribution for a young person trying to game the system by delaying enrollment until he/she encounters the inevitable need for health care.
BUT... so far as I know, this solution isn't in current health reform proposals. Why not? That's where Feldstein sees the invisible hand of the single-payer lobby. As the cost of insurance goes up and up, and as fewer and fewer people are insured, a single-payer system will be the only alternative.
Design a HIE market to fail and you'll end up with a single-payer system. So many of my dear friends, family members, and readers want this outcome that I am in despair. Why do we think that a government monopoly is any better than a phone company monopoly in the way it will treat us? Supporting a move toward public monopoly of payment for health care is to say we want health care to be run the way that public education is currently run. Good teachers underpaid; average income children underserved; rich children opting out.
That's the best I can do by way of diatribe right now.
Have a great day.
Nov 3, 2009
Two Doses of H1N1 vaccine better for children
Here are the findings, in CIDRAP's News of yesterday. Still, if you can get just 1 dose for your child it's worth it, as the first dose confers some immunity and will probably make the flu less virulent in him/her. (This from a non-doc, mind you.)
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