25 October 2007

Don't let them choose

Mort Kondracke, executive editor of the Capitol Hill newspaper Roll Call, offers up conventional beltway wisdom on healthcare reform in a piece decrying the idea that people should be able to choose a public plan.
The case against Clinton's health plan -- and it's applicable to Edwards and Obama as well -- is that by creating a Medicare-like government alternative to private insurance and heavily regulating private plans, people will flood to the government plan, leading to Canadian-style medicine.

As Joseph Antos, a scholar at the American Enterprise Institute put it, Clinton has designed "a reasonably clever way to prove that the private sector doesn't work and have the government swoop in on a white horse. ... [She's] not jumping immediately to a single-payer system -- politically, that's a smart move -- [but] indirectly."

Antos and others contend that Clinton's proposed requirements that insurance companies cover everyone who wants a policy ("guaranteed issue") and charge everyone the same premium regardless of health, age or pre-existing medical conditions ("community rating") will hugely raise the price of private insurance, giving an advantage to her government-run insurance plan.

At a forum last week sponsored by the Kaiser Family Foundation, Clinton said, "We're going to change the way insurance companies do business in America. Right now, [they] spend $50 billion a year trying to figure out how not to cover people. Well, I'm going to save them a fortune and a whole lot of time because the new policy is, no more discrimination, period."

Clinton's $50 billion figure seems to encompass all underwriting, marketing and administrative costs for the insurance industry. She said government programs were far more efficient, but neglected to note that insurance companies provide services like disease management that public plans don't.

Various studies show that several states that have imposed guaranteed-issue and community rating requirements in the past ultimately repealed them after insurance companies dropped coverage and quit selling in the states.

Other studies document that public satisfaction with Canada's single-payer system is low because of long waits for diagnostic tests and surgery. Canada's Supreme Court overruled the government's ban on private insurance.
Kondracke's got a couple things wrong. First of all, Canadians are more satisfied than Americans on their healthcare, and only 8 percent say they'd prefer to switch to the U.S. system.

Second of all, disease management? Disease management is something our private insurance system does well? What?

According to Wikipedia, disease management concerns itself with coronary heart disease, kidney failure, hypertension, heart Failure, obesity, diabetes, asthma, cancer, arthritis, depression, and other common ailments. Exactly the kinds of chronic conditions that American health plans cherry pick against.

Most if not all of these ailments are managed far better in Canada and other universal healthcare nations. Far too often an HMO's management consists of making insurance coverage unaffordable and then, once a person drops coverage, no other insurance plan being willing to take that person on. And in any case, disease management would of course be part of public plans — even today. Because they're a function of the providers. Whether it's the VA or a physician getting paid through Medicare — or even an HMO being paid through Medicare — providers either do a good job or not of disease management. Because there's continuity of care in, for instance, France, disease management is done better than we can manage.

I'm not a regular reader of Roll Call. Who knew it was funded by lobbyists? Makes sense, though. Someone's got to pay the bills.

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