"Genes and behaviour make you ill" Discuss
"Uncertainty drives change and economic development?" Discuss
Gareth Williams wrote:
> Because it spreads rapidly and makes people ill.
>
> Gareth
>
>
> From: "Maynard, A." <[log in to unmask]>
> To: [log in to unmask]
> Date: 23/03/2010 09:11
> Subject: Re:
>
>
> ------------------------------------------------------------------------
>
>
>
> Why is uncertainty a plague?
>
> Adam Oliver wrote:
> > Tom,
> >
> > It's true the Thatcher 'snatched' the milk when she was in charge of
> > education. Pity that didn't stop her from winning three general
> > elections, two of them by landslide.
> >
> > Life is plagued with uncertainty.
> >
> > Sent using BlackBerry® from Orange
> >
> > ------------------------------------------------------------------------
> > *From: * Tom Foubister <[log in to unmask]>
> > *Date: *Mon, 22 Mar 2010 19:10:47 +0000
> > *To: *<[log in to unmask]>
> >
> > Thank you for this Joe - is this a case of classic incremental reform
> > in a country where even incremental reform is painful and has all the
> > air of a big bang about it?
> >
> > I can only think that the Democrats won't suffer for this in future
> > elections - once coverage has been extended (however poor that
> > coverage is, and whatever the associated problems), to 'roll back'
> > reform would look like Congress/the President was taking something
> > valued away. Margaret Thatcher never managed to shake off the moniker
> > Milk Snatcher after withdrawing free milk from primary schools. But
> > maybe I'm underestimating the strength of feeling here?
> >
> > Tom
> > ------------------------------------------------------------------------
> > *From: * Joseph White <[log in to unmask]>
> > *Date: *Mon, 22 Mar 2010 10:09:13 -0400
> > *To: *<[log in to unmask]>
> >
> > Hi Adam and all,
> >
> > Well, the pessimist and congressional scholar in me says, "first lets
> > see the Senate deliver."
> >
> > But the odds are good. So: any policy or political lessons?
> >
> > Not sure, but a few comments:
> >
> > 1) This is still a far cry from what any other rich democracy does.
> > a) It might cover about 95%, if ever implemented (remember, the
> > main provisions do not take effect until a year after the next
> > President is inaugurated, meaning there is a real chance of repeal).
> > b) Compared to a private-insurance-based, individual mandate
> > system in a country like Switzerland, it:
> > 1) Has a much less standard benefit package
> > 2) Puts the poor in an inferior second tier, Medicaid
> > coverage which is likely to have worse access due to some providers
> > refusing to participate due to the unusually low fees
> > 3) Has much weaker cost controls because of the absence of
> > anything resembling all-payer regulation
> > 4) I'm not sure but it seems to require a large portion of
> > the public to pay much more for health coverage, both in premiums and
> > out-of-pocket, in relationship to income, than would be the case in
> > Switzerland. The subsidies are based on the cost of covering about
> > 70% of total costs through the insurance, though there is extra
> > cost-sharing coverage for some lower-income people; and with U.S. care
> > being so much more expensive to begin with, the net effect has to
> > require much higher payments than in other countries.
> >
> > 2) The regulatory structure, though better than the status quo, is
> > quite weak. Most of the core regulation of the individual and
> > small-group markets is left to the states, which are expected to set
> > up the "exchanges". (Tim can go into this at greater length,
> > including how I'm wrong). Benefit packages are allowed to vary in
> > actuarial value (there are four levels), and within a given actuarial
> > value plans can reach that value in different ways. This likely poses
> > an extremely difficult regulatory task, since of course the whole
> > point of varying plans, to the insurers, will be to come up with plans
> > that have the same actuarial values on average but market them
> > appropriately so that they have less value to the people to whom they
> > are sold. Whether the insurers can manage this will remain to be
> > seen. At any rate, the regulatory task is harder than in Switzerland
> > or the Netherlands, because of the greater variation allowed, and yet
> > the regulatory apparatus is weaker.
> >
> > 3) The whole bill does very little to improve the insurance currently
> > used by the largest group of Americans, namely insurance received
> > through employers with more than 50 employees. It does almost nothing
> > to reduce the costs of that coverage. It provides a bit of protection
> > against the risk that people will lose insurance currently provided
> > through those employers. First, employers which do not just drop
> > coverage before the penalties go into effect will, when those
> > penalties take effect, have to figure that cost into the
> > cost-benefit-analysis of what they gain by dropping coverage. Second,
> > employees who lose their covered jobs or whose employers drop coverage
> > will at least have somewhere else to go (the exchanges). But the
> > legislation still leaves most U.S. employers in the ridiculous
> > position of having, as isolated purchasers, to try to win bargaining
> > battles with the insurers (who find it easier to pass on the
> > providers' costs than to fight the providers).
> >
> > So I think it's important to understand that, while this legislation
> > will (if implemented) be a big improvement on the U.S. status quo, it
> > is still a long way from what I have called the "international
> > standard." If the Republicans were a bit more sane, it would be seen
> > as what it is: a fallback position from what most Democrats really
> > wanted, and a moderate compromise.
> >
> > That leads to one observation about politics.
> >
> > 4) The U.S. has become a viciously partisan political system. For
> > years, people believed that the U.S. was a relatively consensual
> > political system, with much less ideological conflict than in most
> > European systems. This was probably misguided even back in the 1960s,
> > as the U.S. left was centrist in European terms but the U.S. right was
> > way to the right of a normal European conservative party, even then.
> > But at that time the two parties were themselves more internally
> > diverse. That's gone now; there is still some diversity in the
> > Democratic party but less than in the past, and the Republicans are
> > pretty monolithic. The Democrats passed (maybe) this legislation with
> > only Democratic votes; and in the end they probably passed it in the
> > House mainly because some of the more uncertain Democrats decided
> > they just couldn't let the other side win. This means that shifting
> > control of the government could lead to policy alternation of a type
> > that makes the British "stop-go" of the 1960s look stable.
> > Ironically, the only stabilizer is the hated, undemocratic, Senate
> > filibuster. And that can be avoided, somewhat, with reconciliation.
> > At any rate, this is another reason to be unsure of whether the key
> > parts of this legislation will be implemented. But it also means
> > that, in the end, the process was a matter of the Democrats who were
> > pretty much liberals and mostly in safe constituencies negotiating
> > with the Democrats who are less liberal and less safe. The latter
> > represented what used to be considered moderate Republican positions.
> > In the end, the bill was a compromise, that appears to be about to
> > pass because of a degree of partisan loyalty that is unusual for
> > Democrats. All along the key question was whether the swing Democrats
> > would decide it was safer not to vote for a bill, or whether that was
> > actually more risky because, if they did nothing, Democrats would look
> > ineffectual. Enough chose the latter -- pending the Senate.
> >
> > cheers,
> > Joe
> >
> > On Sun, Mar 21, 2010 at 10:50 PM, Adam Oliver <[log in to unmask]
> > <mailto:[log in to unmask]>> wrote:
> >
> > So, US health care reform has passed. I'd be interested in
> > reactions from those who commented over the last year; e.g. Tim,
> > Joe, David W. Etc. Etc.
> > Sent using BlackBerry® from Orange
> >
> >
> >
> > Please access the attached hyperlink for an important electronic
> > communications disclaimer:
> >
> http://www.lse.ac.uk/collections/planningAndCorporatePolicy/legalandComplianceTeam/legal/disclaimer.htm
>
>
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