IN THIS ISSUE:
? Galen Event Still On
? Blue Shield’s Bodaken — Universal Mandates
? Individual Ownership – “The Ignored Alternative”
? Kennedy Revisits Employer Pay or Play
? Warmed Over Editorializing in NY Times
? Consumers Storm the Castle Gate
? Christian Science Monitor Suggests Hybrid Approach
? Uwe Reinhardt Bemoans Individualism
Galen Event Still On
No doubt you’ve heard about the Ricin event in Senator Frist’s office. We expect it will be resolved by the time of our Hill Briefing on “Consumer Choice – Reports From The Field” in the same office building on February 11. We’ve had a lot of requests for web-casts, transcripts, etc. from people who can’t get to town that day. Alas, we are a shoestring operation and can’t afford all that stuff. I’ve asked the speakers to submit electronic material that we can put on the web site, but that’s about as slick as we can get.
Blue Shield’s Bodaken — Universal Mandates
The “San Francisco Chronicle” included an interesting exchange of views on the uninsured last week. Bruce Bodaken, chairman, president, and CEO of Blue Shield of California, argues the Democratic presidential contenders are too timid — “It is time to consider an even bolder plan than any of the major Democrats or President Bush have proposed.” He says we should mandate “basic care to every American while spreading the cost broadly among businesses and individuals who can afford to pay.” Basic care would include prevention, physician and hospital care and prescription drugs. Every individual and business would be required to participate and costs would drop because we would end “the administrative expense associated with seeking payment from multiple sources.” Bottom line – he wants a taxpayer-financed single-payer system (probably administered by – oh, I don’t know – maybe Blue Shield of California?) Gosh, if I were a business owner or physician in California, I would think twice about doing business with a company that wanted so much control over me.
Individual Ownership – “The Ignored Alternative”
But another view is presented by Gary Schouborg and Michael Booth. They call it “Free-Market Health Insurance – The Ignored Alternative.” They argue that health reform is often presented as a “forced choice between employer-provided and government-provided insurance.” They say, “But third-party insurance, whether provided by employers or government, discourages insurance companies from dealing squarely with individuals.” They propose a ten-year period in which employers would turn over ownership of coverage to their employees in a coordinated manner. “Such coordination would enable a complete restructuring of insurance company and employer benefits practices.” Premiums would be fully deductible, like mortgage interest is today. Insurance companies would be more responsive, health care consumers would be more careful, employers would pay according to an individual’s worth, and politicians “would have one less goodie to dangle before voters.”
Kennedy Revisits Employer Pay or Play
Although it is probably too conservative for Mr. Bodaken, Ted Kennedy has proposed a national employer mandate that would incorporate “quality-based reimbursement and disease management” to lower health care costs, according to Joel Finkelstein in “AMNews.” Unlike Mr. Bodaken, Sen. Kennedy would not use a single payer system, but like Bodaken, he argues that by reducing waste and charity care, his proposal would save the country more than it would spend on new subsidies. The NFIB is quoted as opposing the idea – “Loading a poorly crafted, astronomically costly regulation on the backs of small-business owners is unfair,” says spokesman Dan Danner. They prefer association health plans, but the article claims that “health policy experts have raised a red flag over this concept.” The article says that “many (Democrats) are still bitter over provisions of last year’s Medicare reform bill and are pushing for changes,” and they are “also pledged to oppose such Republican priorities as individual health insurance tax credits and tort reform.”
Warmed Over Editorializing in NY Times
The “New York Times” must be reading the Democrat’s play book – or vice versa – because in an editorial on “Bush’s Health Proposals” it says the president’s tax credit proposal “does not seem like nearly enough to enable people near the poverty level to buy individual policies (and the AHP proposal) is fraught with potential difficulties?. But (AHPs) would clearly benefit the NFIB, a major Republican Party contributor that could reap substantial revenue selling policies.” Curiously, the “Times” calls the president’s ideas “a skimpy menu of warmed-over health care proposals (that) have been kicking around for years without exciting enough interest to be passed by Congress.” That would actually be a better description of Sen. Kennedy’s “play or pay” mandate that has been “kicking around” for at least 30 years, “without exciting enough interest” to even come to a vote in Congress. In fact, ideas like tax credits for the low-income, premium deductibility for the middle class, AHPs for small businesses, tort reform for physicians, and HSAs for all of us, are refreshing new approaches to solving old problems. When it comes to “warmed over” ideas, the “NY Times” has a corner on the market.
Consumers Storm the Castle Gate
Across town, “The Wall Street Journal’s” Daniel Henninger is also tired of warmed over ideas. He says, “For years, the public-policy debate has so obsessed over ‘Medicare,’ ‘prescription-drug benefit’ and ‘the uninsured’ that one might think the whole country was either enrolled in Medicare, or not insured.” He says “the real action, excitement and potential for improving health-care delivery in the U.S. lies” in the private sector. He reports that the recent World Health Congress was rife with policy wonks talking about “exploding costs” but they missed the real pending explosion – patient rage as people are charged more for diminishing benefits. Something has to give. He cites Rhode Island based Textron which finally adopted a consumer driven health plan and has “refuted all the myths” about such an approach. Other examples included Baylor Health Care System and American Century. “All of the new plans provided tools that let employees access health information of a sort they’d never seen before … if you were a patient — most likely, you’d want what Textron, Baylor and American Century has.” He adds that the criticism of the approach, “adds up to an excuse for doing nothing.” He concludes, “Cost-control is a legitimate issue and a blunt force. Personal autonomy, however, is a newer and ultimately more powerful force. ‘Consumers’ are now at the gates of the American health-care castle. They won’t wait outside forever.”
SOURCE (subscription required): http://online.wsj.com/article_print/0,,SB107542589594316096,00.html
Christian Science Monitor Suggests Hybrid Approach
The “Christian Science Monitor” weighs in on the uninsured, too. It acknowledges that there are a bunch of people without insurance, but it says, “It may be tempting to think that universal health insurance … should be the goal ? But any sort of universal coverage would probably mean some kind of congressional mandate [and] mandates don’t go down well in America’s free-choice society.” It says the presidential candidates “are right to stay away from a complete healthcare makeover, and instead work to fill gaps” in health coverage. It suggests a hybrid package, including SCHIP expansion, an FEHBP-type purchasing cooperative, and a tax credit like the president has proposed. The real question, it says, is “how big a solution to build” — a modest approach covering perhaps 7 million like Bush’s or something more in line with the Democrats’ proposals for covering 21 – 32 million more people? The answer rests on costs, it says, with varying proposals estimated at anywhere from $90 billion to $700 billion over ten years.
Uwe Reinhardt Bemoans Individualism
Finally, Uwe Reinhardt adds a touch of pessimism in an article in the “Denver Post” headlined, “Little Hope for the Uninsured.” He mentions the recent IOM study, but says, “Unfortunately, the task force ended its work in the time-hallowed Beltway tradition of offering readers merely a menu of alternative strategies? all of them well known? and each pitched to a different ideology.” He adds, “The sense of social solidarity that is the sine qua non of universal health insurance coverage just does not exist in this nation of individualists.” He says that “our tolerance for misery among folks who find themselves at the bottom of the economic heap is legendary in the international health policy community.” He concludes, “The only ray of hope” is middle class anxiety over their own coverage that may “eat seriously into the hitherto smug sense of security enjoyed by members of this politically more engaged class?” Ahhh. Nothing like a little self-flagellation to assuage the liberal guilt of a tenured professor.
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