Commonwealth's proposal

Commonwealth Fund's principal researchers and president have authored an article for Health Affairs with Lewin Group modeling that shows a path to dramatically improving U.S. healthcare. It seems far superior to the flawed Wyden plan.

Health Affairs has a firewall, but you can see a synopsis of the plan at Commonwealth Fund or at Medical News Today.

Here are the basics, from Medical News:

• A national entity known as a "connector" that would offer individuals and small businesses a choice of private plans or a Medicare Extra plan.
  
• Requiring that all applicants be given health insurance at standardized rates regardless of their health status.
  
• Tax credits to make sure premiums are affordable. Premium assistance would be available to all to ensure that premiums do not exceed 5 percent of income and 10 percent of income for higher-income tax filers.
  
• Expanding Medicaid and SCHIP to cover all low-income adults and children below 150 percent of the federal poverty level with modest copayments for health care services and no premiums.
  
• Requiring that everyone enroll in a health insurance plan-uninsured individuals who file taxes would be automatically enrolled.
  
• Requiring employers to either provide health insurance or pay 7 percent of payroll up to $1.25 an hour into a pool to help to finance coverage.
  
• Medicare reforms that would extend Medicare Extra benefits to current Medicare beneficiaries, eliminate the two-year waiting period for Medicare for the disabled, and allow adults age 60 or older to buy in to Medicare.

Daily Kos on Obama & single-payer

There's a wonderful essay by a serious healthcare reformer, a professor of Health Policy; Director, Center for Health and Public Policy Studies, UC Berkeley. She writes about Barack Obama and Hillary Clinton (and Hillary's nasty clip accusing Barack of lying about single-payer):

Both of these candidates are very smart people. They both understand that single payer is THE best system for affordable, comprehensive, equitable, secure, efficient health care for all Americans. This is good news.

But the realities of our current system and how it has evolved over time, make it difficult, if not impossible, to move from where we are now to 100% single payer system over night.

I actually proposed this idea of giving Americans the choice of a single payer plan that competes along side the existing system in 2002. I first developed the idea for the state of California as part of the State's HRSA grant for Health Care Options. I will provide links below to both the original proposal as it was developed for California and the a link to the ESRI report (funded by RWJ) on Covering America, which includes the federal model I developed for CHOICE as a plan that would voluntarily transition the entire US health cares system to a single payer system, with private plan options for those who do not want single payer.

Interesting. Here's the link to her site about CHOICE OPTION for California and her federal plan as well -- about which she writes,

The federal plan speaks specifically to the point of having a single payer plan compete with the existing system and allow people to choose which they want. And guess what? Our current inefficient, inequitable, ineffective system cannot compete with a single payer plan. The Lewin Group, using their Health Benefits Simulation Model, modeled the CHOICE proposal and found that within one year of adoption a plan with the option of single payer, 70% of Californians would chose to enroll in the single payer plan and 94.4% of the Californians have health insurance coverage, all without a mandate.

For the sake of the health of the American people let's agree to agree. The goal of health care reform for the Democrats is universal coverage and they all support a plan that will enable the US to voluntarily transition to a single payer system.

'Sick' author Cohn at TPMCafe

Jonathan Cohn's new book, Sick, is this week's book club item over at TPMCafe. Jacob Hacker, Ezra Klein, Matthew Holt, Robin Podolsky, Don McCanne, Roger Hickey, Maggie Mahar and Joseph Paduda will debate Cohn on the options: single-payer, hybrid, or social Darwinism.

Cohn writes, "One of the most striking things about the hybrid crowd is how many of them actually believe, in their hearts, that single-payer is better. For these people, endorsing a hybrid is all about political calculation: Single-payer won't pass, so it's better to get behind a workable compromise."

He thinks that's a mistake: "For one thing, a discussion about changing public policy ought to start with a discussion about which policy would actually work best, whatever the politics."

Cohn refers to his NYT Magazine interview with Safeway CEO Steve Burd, who joined with Andy Stern of SEIU and Sen. Ron Wyden (D-OR) to call for universal healthcare. Burd didn't want to look to government. First he pushed personal responsibility in the form of forcing employees to cover more of their own costs, and then he pushed personal responsibility in the form of employees adopting healthy habits. But it's not enough, is it?

In conversations around the Bay Area, [Burd] heard over and over from hospital administrators about the financial burden the uninsured were placing on their facilities — a burden that eventually rippled through the insurance system and showed up on Safeway’s bottom line as inflated health premiums.

Burd’s first effort to trim costs and keep Safeway competitive involved cutting back on health benefits. Then he tried encouraging his workers to be healthier. Could nationwide universal health care simply be the next step? As long as there were large numbers of uninsured, Burd reasoned, there would be no solution to his company’s — or the country’s — problems with affordable care. And that, he says, is when it finally dawned on him: Maybe this was a problem the company couldn’t solve on its own. If he wanted relief from employee health costs, the government would have to help.

It was not an idea that came easily to Burd, a self-described conservative and Republican...

It's striking how many of the comments to Cohn's TPM piece push the free market mantra. Of course it can push down costs...

Well then why hasn't it? Or more to the point, why has single-payer kept costs down wherever it exists? As it covers everyone? Why hasn't "moral hazard" shot their costs out of the ballpark? Why have their outcomes remained as good or better than ours? For half the cost?

Lastly, how is the health insurance market different than a protection racket? Wouldn't it be better, in the long run, to set up a police department rather than relying on the Sopranos?