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THE GREAT DEBATE.
I'm in In These Times this month moderating a debate between Steffie Woolhandler, co-director of Physicians for a National Health Program and a single-payer supporter, and Richard Kirsch, the national director for Health Care for America Now and an advocate of a hybrid approach.
In some ways, the conversation goes rather like you'd expect: Woolhandler makes a lot of sharp points on the policy questions but has no real answers on the politics. Pressed on how single payer becomes a reality, she says things like, "If you’d asked me five years ago, what was more likely, passing single-payer or electing a black president, I probably would’ve said single-payer and you probably would’ve, too." It's a fair argument, but it doesn't light the way forward. Indeed, likening single payer to exceedingly unlikely political events that require an almost unique alignment of personalities and demographic forces and technological advances is actually an argument to do something else in the meantime. After all, Democrats didn't refuse to support candidates until they could elect a black president. And people need health care coverage now.
Kirsch, by contrast, makes a lot of sharp points on the politics but gets a little fuzzier on the policy. In particular, he heavily emphasizes the need for a public insurance option to keep costs down. That, in fact, seems to be much of the cost control theory behind his plan. But he doesn't have much of an answer for what happens if the public option fails for the same reason single payer would fail. And I'm not convinced that a public plan, on its own, will do much to restrain cost growth at all. Medicare is not exactly a model of restrained spending.
COMMENTS (3)
In this situation, cost control depends largely on the extent to which a plan actually serves as "managed care", limiting choice of procedures, drugs and providers for low-cost (and presumably therapeutically equivalent) alternatives. It's not clear how a government plan might do this unilaterally in a multi-firm environment where enrollment tends to flow to the least restrictive of plans. If we follow the Medicare Advantage model, we'd still need a minimum "standard benefit", lest we see adverse selection. That would mean a restriction on plan offerings, which would require playing some political capital. Furthermore, it's not clear what kind of system efficiencies are possible in a multi-payor environment. Formularies cannot drive as much demand to low-cost winners and doctors' offices still have to cope with the billing systems of numerous insurers.
Posted by: Now you see it now you - | January 21, 2009 2:47 PM
Stein's Law, not Stern's Law. Named after Herb Stein.
Posted by: seriously | January 21, 2009 2:57 PM
It may be there there’s a “third way” that isn’t just hype.
Last week health care advocates in Connecticut released a comprehensive reform proposal (to a cheering crowd of about 1,000) developed by Universal Health Care Foundation of Connecticut for the state called “SustiNet” (it means “sustains” and is part of the state motto). If passed, it would mean that up to 98% percent of CT residents would have quality, affordable coverage by 2014.
The program would create a gigantic health insurance pool by combining the existing pool of state employees and retirees with people now covered under state assistance programs. The pool would also be open to the public, starting with those without access to employer-sponsored insurance, those whose employer-sponsored insurance is inadequate or unaffordable, and employees of small businesses, nonprofit groups and municipalities.
Ultimately, any employer in the state could use the state's pool instead of their own insurance. Employers who wish to participate would pay in as they would any other health insurance plan.
The program also calls for increased use of electronic health records and an emphasis on preventive care, management of chronic conditions and better coordination of care between physicians and other care providers.
SustiNet supporters say that the size of the pool will lead to lower costs. According to the foundation, the plan would save individuals and employers $1.7 billion in 2014 (the plan's first full year of operation), although it would require the state to spend an additional $950 million in 2014.
They also think their plan could serve as a model for other states and for the country as a whole.
More details are at www.healthcare4every1.org. See also the New York Times at http://www.nytimes.com/2009/01/18/nyregion/connecticut/18healthct.html
Could be VERY interesting . . . .
Posted by: Jacob S. | January 22, 2009 9:41 AM