-----Original Message-----
From: Shirley Johnson-lans [mailto:[log in to unmask]]
Sent: 14 October 2009 14:47
To: Oliver,AJ
Subject: Re: US Health Reform
I agree with almost everything stated by David below. And by the way,
this morning Senator Olympia Snowe, the only Republican in the Senate
who has come out in favor of any reform bill, was interviewed on "Good
Morning America", and she also seems to be in favor of a public option,
at least where markets fail to provide any competition.
Shirley
Shirley Johnson-Lans
Chair
Department of Economics
Vassar College
----- Original Message -----
From: "Adam Oliver" <[log in to unmask]>
To: [log in to unmask]
Sent: Wednesday, October 14, 2009 9:35:46 AM GMT -05:00 US/Canada
Eastern
Subject: Re: US Health Reform
Thanks for your posts. Very good. Helps me to understand a bit.
There seems to be a dichotomy between those who think a public plan is
unnecessary and even politically unhelpful (e.g. Ted, Victor, Michael,
Larry), and those who think otherwise (Tim, I think).
________________________________
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of David Wilsford
Sent: 14 October 2009 14:16
To: [log in to unmask]
Subject: Re: US Health Reform
Well, I'm thinking a Nobel Prize looks pretty good these days.
But I shall forgo the temptation to throw my hat into that ring.
I agree with Tim's analysis (as well as Jonathon Cohn's, who he cites),
and with Ted and Michael. The major points bear repeating, because we
will be living with them once the final bill passes:
The premium subsidies are too low to make health insurance really
affordable to lower and middle income Americans; the cost-sharing is
excessive and is likely to continue to drive sick Americans into
bankruptcy; the feeble state-based exchanges created by the bill add
little of value; the individual mandate penalty is too weak and will
leave many Americans uninsured and out of the risk pool; and the co-ops
are dead on arrival.
Unlike others, I do think that the major parts of the Finance bill will
survice House/Senate conference, mostly due to the so-called Blue Dogs,
who, no matter their vilification by the Kool-Aid left, are many of them
running difficult reelections in moderate-to-conservative districts in
the blink of an eye: next year! The Voodoo right will go after all
these Blue Dog gals and guys with great force.
Yes, "we" will get a bill. Another over-learned lesson of the Clinton
93/94 debacle is that the president and congressional Democrats believe
that SOME bill must pass. Some bill, any bill, any bill at all. In
this conviction has been lost the primary question about whether any
bill at all, no matter its defects and dysfuctions, is truly better than
no bill.
The final bill that we get will NOT constitute non-incremental reform of
the system. It WILL reward insurance companies and pharmaceutical
companies, mainly by ensuring them large newly mandated markets, without
any restructuring of incentive structures or any introduction of
meaningful new competitive mechanisms to otherwise constrain pricing.
They are the big, big winners here.
The docs are protected by the bill, as well, because their payment
systems go untouched, and their practice autonomy, such as they may
currently have it, goes untouched. So they are definitely not losers.
Hospitals, neither, seem to lose anything, especially after the ruckus
they kicked up last week, which will scare off any remnants of wanting
to do anything about their payment and operations structures.
In the aggregate, the financial results of the final bill will be
two-fold:
* individuals will pay far more out of pocket for required insurance
than they will think is reasonable, and they will vote their
unhappiness, especially in 2012. (Huge swathes of the population will
also escape mandate altogether, one way or the other, so that the
perversions of picking up their emergency room tabs will continue
unabated.)
* The overall US GDP that goes toward health care will INCREASE rather
than stabilize or decrease, and the RATE OF GROWTH will also increase,
as a result of the final legislation. This macro-outcome will begin to
become evident as 2012 approaches.
In the end, very few macro- or micro-incentive frameworks in this system
will have been changed in any way whatever, meaning that covering more
people will drain immense amounts of new money out of the system. The
US is already, far and away, the largest OECD spender on health care, in
terms of GDP, with pointedly meagre results. The gap in the spread
between the US as the the largest OECD spender and the next largest
spenders will only grow larger each year as a result of this bill.
The president's goals have always been impossibly mixed: increase
access (this bill will do so partially) + restrain costs (this bill does
not: in fact, it will significantly increase them).
So, as Ted rightfully points us back to the iron triangle in health care
dynamics of access, quality and cost: Access will go up a bit, but many
will still be left out, either formally or effectively. Costs will
skyrocket, making us yearn for the days of only 16 percent GDP.
Quality - what America does best: rescue medicine - will remain intact,
with all its functions (really good) and dysfunctions (really terrible).
Yours
David
On 10/14/09 7:16 AM, "Oliver,AJ" <[log in to unmask]> wrote:
It might be interesting to hear whether David, Tim, Joe et al. now stand
on the likely success or otherwise of major US health care reform? Or
you could always stay silent, I suppose - that way you might stand a
good chance of winning next year's Nobel Peace Prize.
Please access the attached hyperlink for an important electronic
communications disclaimer:
http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
--
David Wilsford Ph D
Professor of Political Science, George Mason University (Fairfax
Virginia USA) and
Visiting Fellow, London School of Economics (UK)
[log in to unmask]
French cell +33.6.11.16.50.93
U.S. cell +1.224.522.0111
Please access the attached hyperlink for an important electronic
communications disclaimer:
http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
Please access the attached hyperlink for an important electronic communications disclaimer: http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm
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