06 February 2007

Ezra covers Edwards

Ezra Klein gives John Edwards' health plan a good grade in this crib sheet at the Prospect.
Here's how it works: On first blush, the plan is much like the Wyden initiative, though it puts the onus of the responsibility for funding health coverage on employers... The employers can satisfy that responsibility by either providing comprehensive care, or helping employees purchase from a menu of insurance options provided by newly formed, state-run "Health Markets."

As of now, the plan doesn't explain how much employers must provide towards health market coverage, but it's a safe bet to assume that it's somewhat less than the total cost of health care, and so the incentive will be for employers to encourage their employees to purchase from the HMs. And that's where things get interesting. The HMs will offer a menu of private options that are totally community rated. The plan "will require insurers to keep plans open to everyone and charge fair premiums, regardless of preexisting conditions, medical history, age, job, and other characteristics." These days, though, community rating is a common enough.

Where the Edwards' plan takes a big step forward is in mandating, along with the private options, that HMs offer "at least one plan [that] would be a public program based upon Medicare." And the intent is explicit: "Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."
At his own site, Klein writes that the media coverage of John Edwards' health plan was bad — snarkily compared to Hillary's 1994 plan in the NYT and just given a mushy "it's a tree" description in WaPo: "Reading their coverage, you'd be hard-pressed to distinguish the plan from any other proposal ever offered," opines Klein.

Klein thinks Edwards' plan is a big step forward, because it will allow the public and private sectors to compete with each other. If that were to be the case, I'd feel better about this plan, even though it does seem to be a long way around to the right solution. However, why would the powerful medical insurance lobby ever allow the public sector to compete on a level playing field? Medicare would have to be adequately funded for that, and all the private sector would need to do is ensure that the people signed on to the public program were subsidizing people who couldn't afford insurance and voila — the public subscribers be getting a raw deal. There would also be the same stigma as riding the city bus in Denver.

Can't afford a car, eh?

Maggie Mahar, author of Money Driven Medicine (2006), writes, in a response to Klein at The Prospect:
We don't have the best healthcare system in the world — patient satisfaction is lower in the U.S. and hospital errors are higher — as are mortality rates for many diseases. End-of-life care in the U.S. is both extraordinarily expensive and cruel.

Yet we spend far more than any other country on health care ($2 trillion, of which about $600 billion is wasted) and that bill has been rising by 6% to 10% a year--more than twice as fast as wages or GDP.

By accepting runaway healthcare inflation we are caving in to the corporate interests now running our health care system: Big Pharma, device-makers, for-profit hospitals and lobbies created by some of the highest-paid specialists who do the largest number of unnecessary sometimes unproven procedures.

These are powerful interests, but unless we face them down, healthcare reform will simply mean universal access to unnecessary, sometimes unwanted care at a price that we cannot afford.

This is not a one-time waste of money (like Iraq)--it is a continuous, ever-escalating expense. We have to get a handle on cost if we have any hope for healthcare reform.

I would love to see the Edwards plan empower the public insurer (Medicare) to use its enormous clout to negotiate serious discounts on drugs and devices. Medicare also needs to stop paying doctors and hospitals for volume (fee-for-service).

On March 1, the Medicare Payment Advisory Commission (MedPac) will be releasing a report March 1 that talks about waste in the system--and alternatives to paying doctors for volume. It will be interesting reading.

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