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
>>
>>
>>     
>
------------------------------------------------------------------------
>   
>> *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(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
>