By John Ballard
Via Wonk Room.
Universal medical care will bring millions of new customers into the "market." Drug and insurance companies are salivating. If they come with vouchers and/or newly imposed tax money why should corporate America care? What's not to like about new business?
A "trigger option" would give the private sector another chance to reprise managed health care, hoping this time to make it work. No one sees insurance rationing at the moment. Perhaps two or three more years of rationing will change a few minds.
Not a bad idea. A terrible idea. We already know that HMOs don't keep costs down or increase/improve health care coverage. We don't need to wait for more evidence to accumulate.
ReplyDeleteAnyway, any trigger would kick in just about the time that Republicans have regained the White House. Good luck trying to get the GOP to get behind reforms that a Democratic administration was too cowardly to push through.
So the White House wants to appease liberals by making it appear that they haven't negotiated a bill that mandates everyone to buy insurance from the known totally dysfunctional private health insurance industry while not giving them any shelter from those predators or doing anything the least bit effective to control costs. And that's "not a bad idea"? Just how long do you think it's going to be before another chance to try to rectify health care comes up? A couple of years? Ever looked at history? And you think we should put in a system worse than the current one for the intervening time? I have to say, that's a stretch in my book. It wouldn't appease me, but it would have the effect of convincing me to once and for all wash my hands of the Democrats, who seem to be trying to prove themselves even worse in practice than the Republicans when it comes to health care policy.
ReplyDelete'Scuse me for mentioning it. We'll just have to agree to disagree.
ReplyDeleteIf by some act of Heaven a reform bill makes it into law next year there will be no discernible change in the system for at least four or five years, the lead time allowed for insurance companies to reorganize to accommodate the now non-existent "exchanges" with or without any competing government insurance. No one can predict with accuracy what that will mean in terms of new policies, premiums or risk pools.
The insurance piece is the core of what will change, but no meaningful access will start until several other problems are resolved, including an acute and growing shortage of primary care physicians, a wild disparity of available medical care separating urban, rural and inner city areas, and a shortage of nurses and other medical personnel that already is causing multitudes of foreigners to flock to America when they are desperately needed in their respective home countries.
Add to that list the two main drivers of health care inflation: how medicine is practiced (not evenly cost conscious or cost effective) and a natural human resistance to change. This second challenge applies to both patients and physicians. It is easier to keep bad habits than seek better ones, from neglecting personal health (obesity, smoking, not getting "well care" stc.) to professional changes to more cost-effective approaches to their practice.
Constructing a "trigger" that will almost certainly go off three to five years hence is a tried and true political way through a sticky wicket. It's done all the time in Washington for a range of issues that neither party wants to be blamed for.
One current illustration is the taxes favoring the rich which are scheduled to "sunset" this year. One way that the new president could have won political points early on would have been to urge Congress to end those taxes effective 2009. But the prospect of that last year of increased revenue looked too good to resist, even for Democrats. And in the light of last September's global financial catastrophe and domino effects in housing, jobs, and the rest of the economy everyone got real quiet about cutting the revenue stream.
Back to the "public option" I would be surprised if it passes to see it even come to pass for a year or two. And I don't expect meaningful change in the actual practice of medicine or administration of how it is paid for for ten years or more out. The will be a lot of hoop-la and jabbering at first, but no measurable cost containment for a long time.
@Hootsbuddy
ReplyDeleteI don't see your point, here. You say it will take some time for cost containment to kick in, say 5-10 years. I don't disagree with that or your points about some of the major causes of the health-care inflation (although private insurance company overhead is also one of them). So delaying it even further by putting in a trigger that will "almost certainly" kick in in 3-5 years is supposed to be justified by this? How? If the health care companies are allowed 3-5 years to retool to meet new standards, how can it possibly kick in in that time frame? And why are you so certain that the trigger will "almost certainly" kick in at all?
If no change in the current state of coverage is expected for 3-5 years, and a public option would be up and running in a couple of years, doesn't that mean the public option will provide currently uncovered people with a viable health care coverage option around 3 years before it would otherwise? How many lives would that save?
Washington does "triggers" all the time for issues neither party wants the blame for? Okay, so what is it about health care reform that the Democrats don't want the blame for other than a failure to actually provide it?
And as for rich favoring taxes about to sunset, are you referring to the Bush tax cuts? Er, so how is refraining from killing these a year early an exercise in hanging onto extra revenue by the Democrats? I think they're expecting higher revenue when the cuts do sunset. Maybe they're worried about doing this during the financial meltdown, or maybe they're scared to death of their bosses on Wall Street, but I don't think a year of increased revenue was any kind of reality, much less motivation, for the Dems.
If Republicans regain control of WH or Congress, they can block any attempt to institute whatever Dems might hope would result from a trigger...even if the outcome, say a public option, were built into the current legislation in detail. Congress renegs all the time on things that seemingly had been settled, especially when the item in question is pro-reform and anti-corporation.
ReplyDelete