Hi Adam,
Seems to me that getting universal coverage in the USA has a 'Catch 22'
problem - you need NHI because the system is an 'un-rationalised' mess (ie
NHI should involve system redesign), but you can't get NHI because the
system is not rationalised (ie NHI is said to be 'unaffordable.')
President Carter, for example, said you had to have cost-containment first.
But without the fiscal pressue of NHI, there was no (adequate)
cost-containment.
So suerly now is the time to have a universal system - and then sort out the
inflationary pressures which result by changing the delivery and provider
incentives. If 'spend now, control inflation later' is good enough for the
whole economy (US and UK), surely it's ok to slip in health coverage!
The US institutions were designed -in part - to eschew the 'tyranny of the
majority.' That meant that (in domestic policy) they protect the tyranny of
lots of minorities! Paradoxically of course, when the majority is
reactionary, they protect some residual welfare wedges too.
And re Anna's point - does the federal programme need to avoid (in the UK
lingo) 'post-code lotteries' (or rather post-code discrepancies - they may
not be by chance!)...... which in US terms are substantial inter-state
differences?
Why not? Many major federal programmes do.
Best Calum
CALUM R PATON
Professor of Health Policy
School of Public Policy and Professional Practice
CBA1.054
Keele University
Keele, Staffordshire ST5 5BG, U.K.
Tel: +44 (0) 1782 734867
Email: [log in to unmask]
See: Calum Paton, New Labour's State of Health: Political Economy, Public
Policy and the NHS, Ashgate, 2006
See Calum Paton, 'The NHS after 10 years of New Labour', in Martin Powell
(Ed.), Modernizing the Welfare State: The Blair Legacy, Policy Press, 2008
See Calum Paton, 'Blair and the NHS: Resistible Force Meets Moveable
Object?', in Terrence Casey (Ed.), The Blair Years, Palgrave (Macmillan),
2009
Visit the International Journal of Health Planning and Management online at:
www.interscience.wiley.com/journal/hpm
----- Original Message -----
From: "Adam Oliver" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 16, 2009 9:44 PM
Subject: Medicaid and NHI - NEJM piece
Hi
Attached is a short piece by Michael Sparer on the possibility of expanding
Medicaid to achieve universal insurance. Michael would appreciate your
comments - his email address is [log in to unmask]
All best,
Adam
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