Good question. I take it all back. Adam is eminently plaguable.
-----Original Message-----
From: Maynard, A. [mailto:[log in to unmask]]
Sent: Tuesday, March 23, 2010 8:50 AM
To: Uwe E. Reinhardt
Cc: [log in to unmask]
Subject: Re:
Why bwana?
Uwe E. Reinhardt wrote:
> I am certain that "to plague" someone is "to vex, harass, trouble,
> torment someone. So stop plaguing Adam, Alan.
>
> -----Original Message-----
> From: Anglo-American Health Policy Network
[mailto:[log in to unmask]]
> On Behalf Of Adam Oliver
> Sent: Tuesday, March 23, 2010 6:28 AM
> To: [log in to unmask]
> Subject:
>
> I'm uncertain.
> Sent using BlackBerry(r) from Orange
>
> -----Original Message-----
> From: "Maynard, A." <[log in to unmask]>
> Date: Tue, 23 Mar 2010 09:08:33
> To: <[log in to unmask]>
> 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(r) from Orange
>>
>>
>>
>
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>
>> *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
>>
>>
>
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>
>> *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(r) from Orange
>>
>>
>>
>> Please access the attached hyperlink for an important electronic
>> communications disclaimer:
>>
>>
>
http://www.lse.ac.uk/collections/planningAndCorporatePolicy/legalandComp
> lianceTeam/legal/disclaimer.htm
>
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