Wednesday
Mar042009
Healthcare Reform: Ain't None of 'Em Pretty, Pick One You Can Live With.
Wednesday, March 4, 2009 at 11:41AM
Coffee Brown, University of New Mexico, Talk Radio News
At the Alliance for Health Reform briefing, Covering the Uninsured: Options for Reform, Diane Rowland (Kaiser Commission on Medicaid and the Uninsured) said that 15 percent of us are uninsured.
That’s 45 million people out about 298 million. This uninsured figure includes the fact that 81 percent of the uninsured actually have an employed member of the household. These figures are from 2007 and she expects the number to have risen due to the recession.
Even at 400 percent of the poverty level, 10 percent are not covered.
These rates are not evenly distributed, but tend to be least in the Great Lakes region and progressively worse south and west. The uninsured are about ten times more likely to forego needed medical attention.
Adults without children were the most likely to lack insurance because the eligibility rules are strictest for them even before the recent expansion and extension of SCHIP.
Between 2000 and 2008 the average premium for a family rose from $6,438 to $12,680, with the worker’s share rising from 25 percent to 26.5 percent, for an annual increase of $1,735 per family.
Public support was about two-thirds for healthcare reform both before and after the Wall Street crash, she said.
Ah, but what sort of reform?
Jack Ebeler, Ebeler Consulting, presented the main alternatives, which he boiled down to tweaking the present system or restructuring it. In the first case, he said, we could go with individual or employer mandates. And/or expand existing public coverage, such as Medicaid, Medicare, and SCHIP. And/or revise regulations affecting private insurance.
The other main approach he described would be to move away from employers, either by going to single payer or by redirecting both responsibility and subsidies away from employers toward individuals.
What we are actually going to get is “mix and match.”
Bradley Herring, PhD, Johns Hopkins Bloomberg School of Public Health, presented some pros and cons of each of the major proposals. There are only four to consider:
Single Payer: HR 676
It would be easy to understand, relatively easy to apply, vs. the others, and would deliver large administrative cost savings. While workers and employers would be glad to be rid of premiums, the increase in taxes, especially for the wealthy, would be substantial.
He described this as a transfer of wealth from the rich to the poor, from the well to the sick, and from the Great Lakes region to the poorer states. He also noted that providers would likely see their incomes fall.
The McCain-Republican vision bets on tax code revisions and a competitive market to control costs and drive enrollment. The downside is basically everything we don’t like now: High risk/high cost individuals are separated from the low-risk/high profit pool. There would also be less consumer protections, less standardization of coverage, and high administrative costs at all levels.
The Obama-Baucus plan adds mandates to the current system and gradually brings public sector insurance into competition with the private sector. Advantage: least change. Disadvantage: least change.
The Wyden-Bennett regulates and subsidizes private markets. This one actually gets more bipartisan support, and the Congressional Budget Office estimates it could break even after only a few years. It was almost no one’s favorite.
And there’s the rub.
Rowland notes that two thirds of the people want healthcare reform. Most of them have a first choice among the four plans, and the status quo is most people’s second choice. Most of those polled would rather keep what we have than accept reforms that are not their first choice.
At the Alliance for Health Reform briefing, Covering the Uninsured: Options for Reform, Diane Rowland (Kaiser Commission on Medicaid and the Uninsured) said that 15 percent of us are uninsured.
That’s 45 million people out about 298 million. This uninsured figure includes the fact that 81 percent of the uninsured actually have an employed member of the household. These figures are from 2007 and she expects the number to have risen due to the recession.
Even at 400 percent of the poverty level, 10 percent are not covered.
These rates are not evenly distributed, but tend to be least in the Great Lakes region and progressively worse south and west. The uninsured are about ten times more likely to forego needed medical attention.
Adults without children were the most likely to lack insurance because the eligibility rules are strictest for them even before the recent expansion and extension of SCHIP.
Between 2000 and 2008 the average premium for a family rose from $6,438 to $12,680, with the worker’s share rising from 25 percent to 26.5 percent, for an annual increase of $1,735 per family.
Public support was about two-thirds for healthcare reform both before and after the Wall Street crash, she said.
Ah, but what sort of reform?
Jack Ebeler, Ebeler Consulting, presented the main alternatives, which he boiled down to tweaking the present system or restructuring it. In the first case, he said, we could go with individual or employer mandates. And/or expand existing public coverage, such as Medicaid, Medicare, and SCHIP. And/or revise regulations affecting private insurance.
The other main approach he described would be to move away from employers, either by going to single payer or by redirecting both responsibility and subsidies away from employers toward individuals.
What we are actually going to get is “mix and match.”
Bradley Herring, PhD, Johns Hopkins Bloomberg School of Public Health, presented some pros and cons of each of the major proposals. There are only four to consider:
Single Payer: HR 676
It would be easy to understand, relatively easy to apply, vs. the others, and would deliver large administrative cost savings. While workers and employers would be glad to be rid of premiums, the increase in taxes, especially for the wealthy, would be substantial.
He described this as a transfer of wealth from the rich to the poor, from the well to the sick, and from the Great Lakes region to the poorer states. He also noted that providers would likely see their incomes fall.
The McCain-Republican vision bets on tax code revisions and a competitive market to control costs and drive enrollment. The downside is basically everything we don’t like now: High risk/high cost individuals are separated from the low-risk/high profit pool. There would also be less consumer protections, less standardization of coverage, and high administrative costs at all levels.
The Obama-Baucus plan adds mandates to the current system and gradually brings public sector insurance into competition with the private sector. Advantage: least change. Disadvantage: least change.
The Wyden-Bennett regulates and subsidizes private markets. This one actually gets more bipartisan support, and the Congressional Budget Office estimates it could break even after only a few years. It was almost no one’s favorite.
And there’s the rub.
Rowland notes that two thirds of the people want healthcare reform. Most of them have a first choice among the four plans, and the status quo is most people’s second choice. Most of those polled would rather keep what we have than accept reforms that are not their first choice.
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