Health Care Reform FAQWhat we argue about when we argue about health care policy.
Posted Tuesday, June 9, 2009, at 2:36 PM ET
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StumbleUponShould it include an individual mandate?
No. Uninsured people don't have insurance because they don't want insurance. Forcing them to buy it is a violation of personal liberty. Meanwhile, individual mandates don't actually achieve universal coverage. Just look at Massachusetts, where there is an individual mandate but where 2.5 percent of the population is uninsured. A better alternative would be auto-enrollment you could opt out of. Some people may simply not want coverage: They don't get sick often, or they figure it's not worth the cost. Give them the choice.
Yes. The whole point of insurance is that everyone benefits most when everyone buys in. When a small number of people don't participate and then get sick—and hospitals still have to treat them—the costs are enormous. So there's a strong economic case for requiring everyone to have health insurance. There's also a public-health argument: More people going to the doctor means more prevention, which in turn means less sickness in general.
As for objections that invoke individual liberties, Princeton health care economist Uwe Reinhardt put it this way: "I would say, you're free to not be insured. But we will owe you nothing. That's to say, if you hit a tree, have accident at home, don't come to emergency room. We won't treat you."
Should we model it on the Massachusetts plan?
Yes. The Massachusetts plan has been hugely popular in the state and has succeeded at expanding access to nearly everyone. The plan has all sorts of goodies—an individual mandate, subsidies, and an effective "connector" system to help people buy individual insurance. Also, no public option, which so far has not been an impediment to getting nearly everyone insured.
No. The Massachusetts plan has been a disaster, starting with coverage—all but 2.5 percent is not universal, is it?—and ending with cost: Since the program was implemented, premiums have risen by 10 percent to 12 percent. (That's after proponents said costs would drop 25 percent to 40 percent.) Part of the problem is too many benefits—or rather, the wrong kind of benefits. Not everyone needs coverage for chiropractor visits, yet many people still have it. If the United States is going to model a national plan on the one in Massachusetts, it should at least learn its lesson: Cover the basics—hospitalization, prevention, prescription drugs—and stop there.
Will health reform actually help the economy in the long run?
Yes. Better care may cost more now, but it will save more later. The Obama administration is betting its reputation on the notion that reining in health care costs is essential to the country's fiscal future. If the current 3 percent annual spending growth continues, the administration projects that health care costs will be 34 percent of GDP by 2040. (Scary graph here.) The Council of Economic Advisers has produced a report called The Economic Case for Health Care Reform, arguing that universal care will increase household income by $2,600 by 2020 and increase "net economic well-being" by $100 billion a year.
No. Just because people will get better and more health care doesn't mean they'll get cheaper health care. Many of the mechanisms that are supposed to save money—comparative price analysis, digitizing records, and bundling treatment into "episodes"—are unproven.
Should the Senate use "budget reconciliation"?
No. In the Senate, process is sacrosanct. Budget reconciliation was originally intended to speed along budget bills to prevent government shutdowns. Using it for such political fare as health care reform would be improper.
Yes. The difference between the reconciliation process and the usual route is the difference between needing a 60-vote filibuster-proof majority and a simple 51-vote majority. That's huge. The moderate senators who fall between 60 and 51 are pro-reform but skittish on some of the details. Reconciliation could therefore mean the difference between having a public option and not. As for process: Please. Republicans used reconciliation to pass the Bush tax cuts.
Does it really matter if reform happens this summer?
Yes. Even if Obama signs a bill in October, reforms won't kick in until 2012 or so. Get cracking!
No. Even if Obama signs a bill in October, it won't kick in until 2012 or so. So, no hurry.
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"No. It will destroy private health insurance."
Sounds like it another reason in the "yes" column to me. Private health insurance has been very expensive, particularly when compared with other public health plans. The military (TRICARE), veteran (VHA), and aged (Medicare) health care plans all have significantly lower administrative costs and even with relatively more difficult health groups. There isn't a perfect plan, and each of these has issues, but they have been very effective for their group. TRICARE is the closet to what a national health care plan population would be like and it admin costs are far lower and outcomes better than the typical private health care plan.
Private health insurance works by not paying for coverage. The goal is to not pay for health care needs. Public plans do not try to exclude coverage, as it is politically unfeasible. One never reads about TRICARE not providing a bone-marrow transplant.
-- MacAdvisor
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