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March 08, 2006

Link of the Day

Leif Wellington Haas on universal health care. I've been entering this discussion at a number of waypoints that haven't really allowed for a full explication of my views, but suffice to say I go with a couple axioms:

• The principle of universal coverage must either be built-in or planned for;

• There must be private involvement (I'm actually for a multipayer system a la France, not a textbook single payer, like Canada, but I tend to use the terminology "single-payer" to denote UHC with heavy government involvement. I should probably stop.);

• It must be simple to explain. That's why it must be presented without apology and constructed without preemptive compromise. Once you have a sellable platform, you can try to win over the public. Once you have the public, the stakeholders can demand modification. But you don't start out with a complicated, easily demonized plan in order to seek instant assent that'll never appear.

That's it, and I've found no better expansion of the view than Leif's post. Read it.

March 8, 2006 | Permalink

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Comments

Ezra,

Given your interest in Healthcare and Labor, I think you might like this article by Tim Nesbitt, former president of the Oregon AFL-CIO.

http://www.nwlaborpress.org/think_again/3-3-06Think.html

Also, the Washington State fair share activists are watching Massachusetts very closely right now. Briefly, the state legislature has a bill that would require everyone in the state to purchase some sort of insurance, and compels employers to provide insurance or pay a healthcare assessment. Check out:

http://www.boston.com/news/local/massachusetts/articles/2006/03/06/romney_backs_portions_of_health_care_compromise_unsure_of_others/

Carl

Posted by: Carl | Mar 8, 2006 3:01:40 PM

Good summation, point of view....a good direction to head in politically I would think.

Posted by: Steve Mudge | Mar 8, 2006 4:59:45 PM

Luke Wellington Haase: the U.S. will ultimately adopt a hybrid mixed public and private plan, some version of a European system

Whether it is called pragmatism or realism, a core liberal value is proposing and doing what will work.

So, I fully buy his pragmatism (and Ezra's if he is supporting this idea - other words in other places have suggested a stronger committment to single payer, I thought.)

What I haven't seen is a more detailed explication from this pragmatic camp. What happens to which groups in the current mix?

For instance, for those employers who currently provide adequate coverage for their employees, but at the cost of significant competitive cost disadvantages to their business. How would they get out of the health insurance business and what happens to their employees coverage? Would they select one of the offerings from a FEHBP-like government run pool of private insurance companies that conform to minimum coverage rules and agree to insure all takers? Or something else.

Other categories to discuss:

- Retired employees that obtain secondary-to-Medicare private insurance coverage from their former employers.

- Those currently uninsured, both those able and unable to afford private insurance. Is there a mandate to be insured?

- Those covered by Medicaid, either through income status or disability.

- All those currently covered by Medicare Part D, or receiving drug coverage from their former employers retirement health plan (with the employers subsidized by the federal government). How would Part D be reformed?

- Those currently covered by health savings accounts (HSAs).

The reason I think each category of citizens should be spelled out for the potential next planned step in health coverage is that reducing fear and anxiety has to be taken into account as a major goal. Each person needs to know what their future would look like.

And, of course, this needs to be simple. But simple doesn't mean hand-waving or obfuscation.

Posted by: JimPortandOR | Mar 8, 2006 5:08:14 PM

Max Sawicky had some interesting comments on transition issues that I think warrant addressing.

One thing I've noticed recently in the 3+ years I've been fully immersed in political blogs; this is the most attention I've seen given to universal coverage in that time. This has got to be a good thing.

Posted by: Adrock | Mar 8, 2006 5:25:31 PM

for those employers who currently provide adequate coverage for their employees, but at the cost of significant competitive cost disadvantages to their business. How would they get out of the health insurance business and what happens to their employees coverage?

Some employers here (UK) offer employees private medical insurance at a good discount negotiated with the insurer. (The policies are called "group policies". I assume if someone leaves the job they can keep the insurance but they lose the discount. The employees are of course also covered by the NHS.

So -- that's one kind of answer. But it helps that our medical insurance companies compete for custom because of course they're also competing with the NHS.

I see three major problems facing someone who wants to change the US system. 1. So many US people are convinced "socialized medicine" is Satan -- or, so many noisy ones are. 2. Doctors in the US are -- like doctors in the UK, now! -- comparatively highly paid. 3. *Insurance companies* have a vested interest in the status quo -- of course.

Posted by: jayann | Mar 10, 2006 7:33:00 AM

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Posted by: peterwei | Oct 22, 2007 7:16:05 AM

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