Blue Mass Group

Reality-based commentary on politics.

Health Care: Locked and loaded on the federal level

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This week, Senate Finance chair Max Baucus released his preliminary outline of an eventual health care bill. This is significant because the Finance Committee spends the money, and that Max Baucus is not Ted Kennedy, who chairs the Health Education Labor and Pensions committee. So it indicates a degree of cooperation in the Senate that was lacking in 1994.

Ezra guides us through the plan. These things may seem familiar to Massachusetts residents!

  • Pay or play for large/mid-size employers: Offer insurance to employees or give money to a pool for the uninsured.
  • Pool together individuals and small groups; create an entity called the Connector the Health Insurance Exchange where such folks can easily compare plans.
  • Personal mandate; subsidies for folks making <400% of poverty level. (In MA it's 300%.)
  • Outlaw exclusions for pre-existing conditions (guaranteed issue).

It also calls for a federal Comparative Effectiveness Research Institute, which would give the marketplace unbiased research on the relative effectiveness of various treatments. Considering how much in health care is left up to the folkways of physicians, and not hard data, this is a most welcome suggestion.

The big big difference may please single-payer folks: A federal alternative to private insurance. That is, you can buy into a federal plan that works in direct competition with the private plans.

Now, the insurance industry won't like this. And in their lobbying, they will try to strip this out, or make it as crappy as possible so that it gets a bad name and becomes the insurer of last resort. But it doesn't have to be this way. If enough people find it valuable, then it will become a cherished part of the federal government, something that genuinely makes people's lives better. That will surely mark a gut-check for Congress — but it's one of the most effective things they can do. If government does the job better, why shouldn't it?

Anyway, this is exciting stuff, and it's remarkable to see the essential unanimity between the Edwards, Clinton, Obama, and now Baucus plans — with the exception of the personal mandate, but maybe even that's not that big a deal.

The world apparently looks to the Massachusetts model as something that can potentially work. We know here that it's nohow ideal, that it still leaves us with spiraling costs, and that addressing the access problem doesn't solve the supply problem. But we're better off than we were, and we were already better off than most of the country.

I'll be continuing to dig into the Baucus white paper for how it addresses health care costs, since that's the part that goes way beyond the access problem to, well, the solvency of the federal budget itself. Fun fun.

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  3. There’s a moral imperative to speak out against health care policies that cause harm, and the MA Plan is harming all of us–some people MUCH more than others–both by limiting access to needed care with forced policies that have high deductables, co-pays, limited choice of doctors, etc, and by worsening (with the mandate but no public plan option) the economic rape of society by the insurance-pharma-medical-industrial complex. Pardon the long comment here, but knowledge is power and we definitely need to bring mega people-power to this fight. We can do much better than the MA Plan; this can happen but requires that more people actually understand its details so it’s not allowed to serve as a template for the country!! On the state level, we have the obligation to undue the harmful aspects of the MA Plan ASAP and replace them with something better, ie add a public plan option, community rating required of the private insurers (until they wither away), a care-share ratio to limit admin. spending, etc.

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    p>The MA Chapter 58 MA Insurance Mandate Law is, sadly, largely fake reform as it did not attempt ANY meaningful cost controls. The MA law doesn’t make nary a dent in sky-high cost of insurance and health care in our state; it was crafted by the Heritage Foundation along with Blue Cross Blue Shield of MA. What this insurance law (not to be confused with a health care law) has done is wasted huge sums of public money while perpetuating enforced poverty on thousands of residents who must now limit their meager income to stay eligible for state-subsidized coverage and avoid tax fines.

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    p>If the Bachus/Kennedy/Obama plan includes a meaningful public insurance option it just might constitute real  “reform”; the devil’s in the details so I offer the below as “A look at some of the details”.

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    p>Here’s what a few thoughtful folks, including Paul Krugman, had to say about the Baucus Plan

    New York Times, November 12, 2008

    Hopeful signs on health care, by Paul Krugman

    This is very big news. One of the key questions about the new Democratic majority was whether Congress would try to play it safe, backing down on big ideas about reform, especially on health care. You can view the whole chorus about how we’re still a “center-right nation” as an attempt by the usual suspects to scare Democrats into scaling back their ambitions.

    But now Max Baucus – Max Baucus! – is leading the charge on a health care plan that, at least at first read, is more like Hillary Clinton’s than Barack Obama’s; that is, it looks like an attempt at full universality. (The word I hear, by the way, is that Obama’s opposition to mandates was tactical politics, not conviction – so he may well be prepared to do the right thing now that the election is won.)….”

    read full article and comments at
    http://krugman.blogs.nytimes.c…

    SELECT COMMENTS:

    Well, I just read the Baucus proposal. All I can say is that all these plans that have the word “buy” in them aren’t going to fix anything and certainly don’t amount to universal coverage. The citizens of most developed countries – except the United States – “pay” for health care through taxes and otherwise have hardly any out-of-pocket costs. THAT’S universal health care! Like France! A key component is not having to worry about how one can pay for it.

    I don’t need another opportunity to “buy” health insurance, especially since having health insurance is no guarantee of ever getting any procedure or care paid for… One of the reasons people don’t buy health insurance is that it’s largely worthless unless you don’t need it. No, that doesn’t make sense, and neither does the notion of making us buy it.

    – John H. Farr  November 12, 2008
    ————

    What John H. Farr said!

    Still, while this is much less than true single-payer, it appears to be much more than a timid baby step.

    My hope is that the government plan option is so successful that private insurers simply wither into irrelevancy.

    – Rob Lewis  November 12, 2008
    ————-

    As someone who has been pushing everyone, including some Nobel laureates, toward universal health care for a couple of decades, I am happy. Ah, I’ll continue to push. We must forget this “children only” nonsense. Children need parents too.
    Not to mention that there are reasons to be suspicious of “Nur fuer Kindern” health care.

    – anna  November 12, 2008
    ————–

    “Obama’s opposition to mandates was tactical politics, not conviction – so he may well be prepared to do the right thing now that the election is won.”

    Why should we wait and see if Obama does the right thing? Better for us to demand that he do it from the start.

    And while you’re mentioning Max Baucus’ plan, it’s not the only plan in town. There’s a plan that Ted Kennedy is putting together and John Conyers is the sponsor of HR 676, a single-payer plan that already has more than 90 cosponsors. I hope you’ll be examining all of these plans.

    – corinne  November 12, 2008
    ———

    I hate to rain on this parade of tears of joy, but Prof. Krugman, you are conflating terms. Universality is referring to the purchase of commercial health insurance policies and not to health care.

    Please be consistent and clear in what is being discussed, because these two terms are not even related. They have at least five degrees of separation: access, affordability, quality, appropriateness and eligibility.

    I blog about this ad nauseum at the Home of the Brave blog:

    http://revolutionredux.wordpre…

    – Annie, Massachusetts  November 12, 2008
    ———

    I think a universal health insurance is long overdue in this country.

    However, the concept of employers being responsible for private health insurance is inconsistent with the notion of universal public health insurance.

    A cleaner system is where employers pay salary, government taxes salary, government pays for health insurance. It works fine in Europe and can work fine here

    – Bill

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    p>Knowledge is power and we need as much grassroots political power as can be mustered as the reform process moves forward–the insurance-pharma industries are surely planning their attacks already. For info. on building a social political movement for real health reform and how YOU can get involved, please visit
    http://www.HealthCareForAmeric… & http://www.HealthCare-Now.org (for national reform campaigns)
    and http://www.MassCare.org (for state reform campaigns)

  4. A quote by General Robert H. Barrow, USMC dovetails nicely to the discussion of health care.  Anyone using the present system experiences the months wait to see a doctor, being then sent to another specialist for has another wait, maybe misdiagnosed and have to go round again.  The sad part is that the present system is terrible.  

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    p>Having the government be a partner does not mean progress.  If we believe the same people that take away our legal rights, involve us in endless war, destroy our financial system is going to help us, then maybe we should be on meds.  We’ve all heard or experienced the medical care from the present government systems.  Importing the horror stories of the VA and BIA to a national plan just doesn’t sound like progress to me.  

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    p>How about defining the problem?  Is it access to medical treatment?  Is it the cost of treatment?  Do we have an already overburdened system?  In Canada, where they now have a problem of people dying as they wait for care, they have a safety valve of sending people to the US.  We would have no such safety valve.  Whether we like it or not, as more people have access to health care, more people will use it. Will that bring collapse?

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    p>While politicians like to talk this up, I haven’t heard viable logistical talk of getting viable health care to the masses that will improve the life of the average citizen.  They talk of medical care as if it were free beer.  I’d like to see the problem defined, solutions identified, costs considered and if a government resolution is possible, fine.  If not, take it off the table.  I’m not if favor of a future health care bailout.    

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    p>

    • This comment is sorely uninformed and lacking in logic. Other than that, it’s great.

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      p>1. “The same people that do xyz bad things can’t be trusted,” etc. The Obama administration will not be “the same people” as the Bush administration. It matters whom you elect. Besides, what the hell does Gitmo have to do with the VA?

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      p>2. “Horror stories of the VA”? Indeed. Please remember Walter Reed was a US Army hospital, not VA.

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      p>3. The problem is indeed both access and cost. The Baucus plan addresses both — maybe well or badly, but it does address them.

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      p>Your assessment of Canada is both hyperbolic and irrelevant, since neither Baucus, Kennedy, Obama, or even Hillary Clinton are talking about Canadian-style single-payer. “People are dying”? Apparently not — and certainly not more than those who die from not having insurance, as in the US.

      <

      p>How about reading, or even skimming Baucus’ plan (or Obama’s, or anyone’s) instead of complaining about how the logistics haven’t been dealt with, and how those clowns in Congress are just a bunch of clowns?

      <

      p>Awesome comment, dude. Come on back soon.

      • I don’t understand “Gitmo and VA”.  I trust you never dealt with the VA.  Where did the idea that Walter Reed was a VA hospital come from?   Perhaps you read my comment backwards and upside down.  Was there a “Paul is dead”, too. Perhaps the magic world is better for you.

        • … those who have looked into the VA have been impressed:

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          p>

          Indeed, the VHA’s lead in care quality isn’t disputed. A New England Journal of Medicine study from 2003 compared the VHA with fee-for-service Medicare on 11 measures of quality. The VHA came out “significantly better” on every single one. The Annals of Internal Medicine pitted the VHA against an array of managed-care systems to see which offered the best treatment for diabetics. The VHA triumphed in all seven of the tested metrics. The National Committee for Quality Assurance, meanwhile, ranks health plans on 17 different care metrics, from hypertension treatment to adherence to evidence-based treatments. As Phillip Longman, the author of Best Care Anywhere, a book chronicling the VHA’s remarkable transformation, explains: “Winning NCQA’s seal of approval is the gold standard in the health-care industry. And who do you suppose is the highest ranking health care system? Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the veterans health care system outperforms the highest-rated non-VHA hospitals.”

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