Finally, straight talk on health care reform. I mentioned earlier that the President's proposal to increase access, preserve consumer choice, and control costs -- while responsive to what people say they are concerned about in polls -- does not hang together.
Today the New York Times says the same thing:
For Congress and the administration to keep the promise of comprehensive health care reform, they will have to find the political will to pay for universal coverage and other investments that are needed right away but will not produce quick savings.
And see my comments below on the concept of "accountable care organizations." How is that compatible with consumer choice? Perhaps the Times can address that one in their next editorial. People in the Massachusetts State House and in DC are not yet doing so.
I say, focus on access first. Change the national insurance laws to do what MA did years ago, things that made it possible to achieve the expanded access provided by Chapter 58 of the Acts of 2006. Get rid of provisions that allow insurers to use pre-existing medical conditions and other such factors to turn down patients. Go beyond this, perhaps by using a model like that of the Netherlands:
All people are required to have insurance and can purchase it from any of a number of private insurance companies. Some of these companies are for-profit and some are non-profit. . . . No company can refuse to provide coverage to any person. . . . The government subsidizes the cost of insurance to people with low incomes. The insurance covers the full range of medical diagnostic and treatment services. You can also buy supplemental insurance to cover things like single rooms in the hospitals, cosmetic surgery, and the like.
Beyond this program of "cure" insurance, there is a separate government program for "care". This covers long-term care and other parts of the medical care spectrum that are essentially uninsurable.
Further, I would hold off creating a new public insurance plan for basic care until we see how this system works. Public policy works best when changes are made incrementally. There are always unintended consequences. Best to take it a step at a time and build in opportunities for mid-course corrections.
You cannot quickly revise the structure of an industry that has evolved over half a century. Perturb it in the direction you want to go. The first step is to get people covered by insurance.