Many Thank for your answer, 
with a basic condition maybe: a guarantee of good quality, this means 'good' coverage (at least a sufficient basic package).

Best, Stefania 


De: Anglo-American Health Policy Network de la part de Shirley Johnson-lans
Date: mer. 14.10.2009 17:58
: [log in to unmask]
Objet : Fwd: RE : US Health Reform

----- Forwarded Message -----
From: "Shirley Johnson-lans" <[log in to unmask]>
To: "Moresi-Izzo Stefania" <[log in to unmask]>
Sent: Wednesday, October 14, 2009 11:57:23 AM GMT -05:00 US/Canada Eastern
Subject: Re: RE :  US Health Reform

Dear Stefania,
 Since I regard "economic structure" as also about the structure of markets, I would say that a really good public option  should serve the purpose of providing more competition in regions (particularly sparsely populated low-income regions) where there may be few private insurance companies willing to operate. 


----- Original Message -----
From: "Moresi-Izzo Stefania" <[log in to unmask]>
To: [log in to unmask]
Sent: Wednesday, October 14, 2009 11:50:43 AM GMT -05:00 US/Canada Eastern
Subject: RE :  US Health Reform

My last words:

On reading the Sparer comments concerning the challenge to integrate (...) the 'public plans' (really interesting), I would like ask maybe something trivial: 

Is this just a health sector problem or an economic structure question: too high gap between the different incomes, which means a 'considerable' need of public means independently of the aid model choose?




De: Anglo-American Health Policy Network de la part de Michael Sparer
Date: mer. 14.10.2009 15:49
: [log in to unmask]
Objet : Re: US Health Reform

Perhaps I'm overly optimistic, but I see it a bit differently.  Seems
to me we will end up mainly with a Medicaid/SCHIP expansion (combined
with a relatively individual mandate), which is hardly a surprising
ending and also is not such a bad ending.

For example, under the Finance bill, 14 million of the newly insured
will be on Medicaid and a million or so will be newly added to SCHIP. 
Moreover, according to the CBO, of the 25 million still uninsured
(under the Finance bill), roughly 11 million will be eligible for
Medicaid but not enrolled, another few hundred thousand would be SCHIP
eligible but not enrolled,  and roughly 8 million will be undocumented
immigrants.  That will leave roughly 5 million uninsured who are
neither Medicaid nor SCHIP eligible.

My prediction is that in a few years Congress will do another bill
which will add these "gap" folks to the Medicaid/SCHIP rolls, along
with adding some of the others who will be floating along unhappily
with inadequate subsidies over the next few years on whatever
state-based exchanges are created.  This is the path to national
health insurance in the US.

The keys then (and now) will be to figure out 1) how to get the
eligibles but enrolled to actually enroll, 2) whether the state-based
Medicaid infrastructures can handle the enrollment growth, and 3)
whether the ever growing "public plans" (Medicaid/SCHIP/Medicare) can
drive needed changes in reimbursement strategies, care management, and
the like.

I know there are many who have major problems with Medicaid
(especially among the provider community), but it seems to me that
Medicaid is the public program that will continue to drive efforts
around the uninsured.  And as for the reimbursment issue, either we
eventually push for some sort of all-payer reimbursement proposal, or
we fix Medicaid's reimbursement approaches.

And at some point we will also need to decide as a society what we are
going to do about the undocumented.

Michael Sparer