"there plan"? Who do you think you are, Yglesias?

"provided by the private sector" ? I'm confused.

I couldn't help but notice this part of the CBO analysis: "Not surprisingly, a number of uncertainties arise in attempting to predict the effects of such large-scale changes to the current health insurance system. Although we have provided a range of results that reflect our current expectations about likely outcomes, actual experience—and the results of a formal cost estimate—could differ substantially in either direction."

Of course there were FOUR CBO reports and one GAO report in the early 1990s that said single payer was economically best; see:

http://www.pnhp.org/facts/single_payer_system_cost.php?page=all

But let's say that Wyden gets to universality (I doubt it) and is revenue neutral to government costs. There are at least two huge issues:

1. What are total out of pocket expenses to people. That is the often overlooked part of "costs." There are costs to the system as a whol or to government. But the key voter cost is total out of pocket (tax, premium, deductible, copayrs, denials, out of coverage, etc.).

2. What is quality of coverage? Universal is a deliberately sloppy term. What is the content and quality of coverage? Is the only affordable plan crappy high deductiable, high copay, covers very little?

Here are the four simple questions to ask of any health care proposal.

1. Is it Universal (covers all people)... but just that is not enough, you must also find out how the proposal deals with items 2, 3 & 4:

2. Is it Comprehensive (does it cover all needed conditions, prevention, treatment)?

3. How much is it going to Cost Individuals; is it affordable year-in and year-out and can you afford to get sick (their total cost in taxes, premiums, deductibles, copays, uncovered conditions/expenses, total out of pocket...)?

4. How much is it going to Cost Overall, total cost of the system to the country (and yes, we do need overall cost-control); and how is it paid for, and who is paying, all the pieces, direct and indirect?

Too many folks don't seem to get that it is not real Universal Coverage, IF that Coverage is really "coverage" because it leaves you with too much legitimate care not actually covered, leaves you with high out of pocket expenses, and total system costs keeps rising as percent of GNP.

Sorry,,, I still support the CBO & GAO pre-approved HR-676.

I'm not buying that universal health care will pay for itself any more than I am that tax cuts or the Iraq war did. If the Wyden plan really is revenue neutral by year 2, then it's not remotely ambitious enough. Try again.

is fully financed in year one (the year of transition), revenue neutral in year two, and creates surpluses after that.

Lol. Wow.

Ezra,

I'm willing to make any wager on this one of your choice. Seriously.

PS As this plan gains traction, here's an issue that needs significant attention: what's the projected impact on total compensation to employees? While there are mechanisms in place to transfer employer health care spend into salaries for a few years, what will prevent erosion of this such that employees don't lose out by the a decade point?

Comment of the Day by PNHP's
By Don McCanne, MD

http://www.pnhp.org/news/2008/may/cbo_looks_at_wydenb.php

S. 334, the Wyden/Bennett Healthy Americans Act, would “require individuals to purchase private health insurance and to establish state-run purchasing pools and a system of Federal premium collections and subsidies to facilitate those purchases.”

Although the bill has provisions that nominally would slow the increase in health care costs, they are similar to the cost-containing provisions of the proposals of the presidential candidates that actually would have very little impact, if any, on slowing cost escalation. It became apparent that adjustments would have to be made in S. 334 to prevent increasing demands on future federal budgets.

Under this proposal, the value of the basic standard option would be indexed to the overall growth rate of the gross domestic product (GDP). Since the growth rate of actual health care costs has always exceeded the growth rate of the GDP, the difference between actual costs and GDP growth will have to be met either by a reduction in the benefits of the basic option or by an increase in the premium paid by the insured, or by a combination of both. This has the impact of shifting some of the responsibility of paying for care from pooled government funds to the individual.

The premiums to be collected would no longer be tied to the average premium amount as they would have been in the original proposal, but they would be tied to the least expensive plan available. The difference between the minimum premium and the average premium would have to be paid by the individual. This also has the impact of shifting some of the responsibility of paying for care from pooled government funds to the individual.

Since the tax deduction allowed would be a fixed amount rather than varying with the premium, the difference would lose its tax advantage and shift more costs to the individual. Once again, this has the impact of shifting some of the responsibility of paying for care from pooled government funds to the individual.

Over time, health care spending for the government would be stabilized to a greater degree, but at the cost of shifting more of the responsibility of paying for care to the individual.

What we really need is a system that removes the financial burden from patients and more effectively pools our funds into a public program that is able to address costs much more effectively by introducing greater efficiency and value into our health care system. Depending on private plans, while placing a lid on government spending, won’t do it.

Revenue neutral?

By forcing people to purchase insurance at whatever the insurers want to pay?? Revenue neutral to whom???

I agree that this plan faces significant political problems. The defeat of Arnold Schwarznegger's similar mandate in California provides a template for defeating this bad idea on the national level.

Good points, Shum, thank you.

DrSteveB's "Four Questions To Ask" is great; what a user-friendly evaluation tool! I plan to make it available to the general public, starting on Sat. May 3rd at the Latino Summit for Health Equity and National Health Insurance taking place in Meriden CT. (Congressman Chris Dodd is one of the keynote speakers, see http://www.latinosnhi.org for info)

Steve's four questions go a long way toward determining if a particular plan, e.g. Wyden-Bennett, or Conyer's HR 676 for Nat'l Health Insurance (HR 676 has 90 Co-Sponsors), has the policy details needed to guarantee quality affordable healthcare for all.

btw The Massachusetts Plan is failing badly on all four questions while it bankrupts our state. Not a pretty situation to be living through.

Yes, single payer's better. But few of us in 94 thought that the political system would stand idly by and watch a 14 year haphazard private insurance death spiral of medical inflation and rising uninsurance rates. Never ever underestimate the capacity of our political institutions to cotninuing driving off a cliff. Take what we can. Then build on it.

But we don't have to be totally passive about what reform bills get considered, do we? (Re: "Take what we can. Then build on it")

Politics and policymaking do indeed involve negotiation and compromise -- but to my thinking, both as a nurse and a caring citizen -- the goal of creating an equitable affordable healthcare system belongs in a somewhat different category than ho-hum policymaking.

Guaranteeing (not "mandating", mind you) equitable healthcare access, cost, and quality is essential to being a civilized society. It is fundamental to life, liberty, and the pursuit of happiness, and to basic human dignity. This fact is why every other industrialized country on earth has a form of national healthcare for their people (and spends on average half the cost per person).

Many Americans are beginning to see that it is immoral and hence unacceptable to "take what we can" from the majority of politicians who are not yet willing to put constituents health and financial needs first.

It would do a lot to restore people’s faith in government if a public commitment was made by politicians and public agency leaders to put patients before profits in health reform and enact not-for-profit social insurance with a private delivery system on the federal level with HR 676 (see http://www.healthcare-now ).

One final important point: it doesn't seem smart to cave on policy details before negotiations have even seriously begun.

If you are going to claim that it won't cost any additional money, then it better not cost any additional money. Most of us remember the Medicare and Medicaid and Medicare Part D estimates, and how they all actually cost ten times more than estimated. We won't be lied to again.

Ezra, unless wikipedia is lying about your age, you were 10 years old in 1994 (I was 9).

How is it that you know so much about it? Do you have books to recommend?