« Hillary and Drivers Licenses | Main | Vouchers and Health Insurance »

October 31, 2007

Universal Health Care in New Mexico?

That's what Richardson is proposing. You sort of wonder how he had time to draw up the bill given all the campaigning, and how he plans to shepherd it through the political process given his expectation to be on a national ticket in a couple months, but whatever. I'm always happy to see another UHC bill offered up, even if it is just so the candidate can mention it in speeches for higher office. Maybe a post-campaign Richardson or his successor will actually make it a reality.

While I'm on the topic of state-based universal health care plans, I should mention, because I didn't make it clear last time, that I really would like to see single-payer tried on the state level. I don't think states can sustain these public-private hybrids, but they may well be able to keep up single-payer.

October 31, 2007 | Permalink

Comments

I should mention, because I didn't make it clear last time, that I really would like to see single-payer tried on the state level. I don't think states can sustain these public-private hybrids, but they may well be able to keep up single-payer.

Could you actually expand on this in a future post?

Posted by: Christmas | Oct 31, 2007 9:35:20 AM

Which part? If the first, go read my Washington Monthly article overstated, which explains in detail why state plans fail.

Posted by: Ezra | Oct 31, 2007 9:49:37 AM

As for me, the second. Why don't your arguments that the hybrid model is doomed to failure at the state level apply just as well to the single-payer model?

Posted by: Brock | Oct 31, 2007 9:59:36 AM

Single payer at the state level would at least have an out to it. When CA or NY so bungles their system it goes bankrupt all you have to do is pack up and move. I'm sure it would be quickly followed by a federal bailout though, never easy to escape bad politics.

Would this State Single Payor (SSP) take the form of HI or more like everyone joins the states' self funded pool? Would SSP be paid 100% by state funds or have a heavy dose of federal redistribution?

I think what other voters decide to do in their state is none of my business, as long as they aren't trying to tax me to do it. Wouldn't SSP be the ideal solution to resolving this dispute? Caring intelligent progressives can create their utopian wonderlands at the state level and us cruel, ignorant conservatives, could ogle from our failure states in between. Why fight trying to impose our wills on each other, we call a truce, retreat to our respective sates, and wish each other long and prosperous lives.

Does anything think it is more efficient to mail your money to DC then beg for it back? Keep it local!

Posted by: Nate O | Oct 31, 2007 10:06:28 AM

Well, this report shows very clearly the hurdles that stand in the way of a single payer system. Going in this direction would really be a travel one bridge too far, just like Clinton's misguided plan of the 90s. It's totally counterproductive to disregard the resistance of lawmakers and lobbies, not to speak of that most voters don't like revolutions, either.

One other point: The commission found single payer to be the least costly plan for New Mexico. Ok, that may be true in the short, maybe even the middle run. But I'm a fan of Parkinson's law and so I have to ask the question: What incentives will prohibit this heathcare administration from becoming a costly bureaucratic behemoth sooner or later, when there won't be any other market players providing a counterforce or at least a possibility of comparison?

Imho this is where Clinton's new plan is at its strongest: Putting both the expanded Medicare and the private insurers in direct competition. Market forces will help all suppliers to be constantly aware of cost control in order to stay attractive for customers. And all that is needed to achieve an improvement in heathcare coverage is open up Medicare for every customer and implement a law obliging insurance companies to offer a 'Medicare standard' product to everyone. The market will do the rest. Imho this plan is ingenious in its simplicity.

Posted by: Gray | Oct 31, 2007 10:34:03 AM

Why could the state not afford it and the Fed could afford it? They both can and do tax.

I think it's just that you can rationalize a bad idea better when the "federal government" is paying for it.

Posted by: Josh | Oct 31, 2007 10:58:46 AM

The presidential candidates should add in a state-level single-payer option to their health insurance proposals. The Feds could make it much easier for single-payer to work for any state that wanted to try it.

Posted by: Rev Transit | Oct 31, 2007 11:02:52 AM

I'd love to see this put into action in NM since I have several family members there, most of whom will oppose such an idea just on the face of it. But you're right to wonder when Richardson will have time to do anything about it. Denish is the most likely next governor no matter what, and I don't know if she has any plans in this area at all.

I think it's just that you can rationalize a bad idea better when the "federal government" is paying for it.

No, it's that 49 of our states can't deficit spend while the federal government can. What conservatives don't get about deficit spending, of course, is that it's not something that should be done to extremes all the time. However, if the federal government wasn't running constant deficits, then during economic downturns, when more people need help with social services, the feds could deficit spend for a few years to keep services like universal healthcare running. States can't do it.

Of course, conservatives want the government to deficit spend all the time because it gives them bombs to play with and they can point to it as "evidence that government doesn't work."

Posted by: Stephen | Oct 31, 2007 11:16:10 AM

Well, this is going to offer hours of fun debate with my conservative in-laws when we go to Albuquerque for Christmas.

Posted by: James F. Elliott | Oct 31, 2007 11:21:19 AM

"Why could the state not afford it and the Fed could afford it?"
Economies of scale. Most states are simply too small to implement a new system on their own.

Posted by: Gray | Oct 31, 2007 11:43:17 AM

"Well, this is going to offer hours of fun debate with my conservative in-laws when we go to Albuquerque for Christmas."
Happy holidays.
|-(

Posted by: Gray | Oct 31, 2007 11:44:22 AM

New Mexico is one of the poorest states in the nation. The quality of single-payer health care would be crappy in any state, but it would be especially crappy in New Mexico.

Posted by: JasonR | Oct 31, 2007 1:53:29 PM

"New Mexico is one of the poorest states in the nation."
Another reason why universal healthcare should come from the feds instead.

Posted by: Gray | Oct 31, 2007 1:56:01 PM

Which part? If the first, go read my Washington Monthly article overstated, which explains in detail why state plans fail.

I've read your Washington Monthly article, and I thought it made sense. What I'm genuinely curious about is why you think state-level single payer would be more viable, and I'd like to see you expand on that thought.

Posted by: Christmas | Oct 31, 2007 2:36:52 PM

Gray if each state was to start an insurance company to insure it's residents that insurance company would be larger then most licensed insurers today. 1,000,000 is more then a large enough pool to run an insurance program. Not to mention I'm sure all states would ceed rish off to smooth things out. There are 100,000s of employers that self fund their benefits and they are as small as 15 employees.

Stephen, every state I'm aware of is well in the red, now that they must account for future pension and healthcare liabilities they are billions in the red. No one state can borrom on the level of the Fed obviously but that doesn't stop them from trying. You seem to have quit a bit of disdain for conservatives and their budgets, how about Chicago, Detroit, DC, and any number of other democratic controlled cities awash in the red?

Posted by: Nate O | Oct 31, 2007 5:17:37 PM

You sort of wonder how he had time to draw up the bill given all the campaigning,...

As usual he's taking credit for a lot of peoples' work. This effort has been going on here for many years. See:

http://www.healthactionnm.org/hcfa/index.php

Posted by: Michael H Schneider | Oct 31, 2007 8:08:15 PM

Sorry about forgetting to close the HTML tag. I have the same problem with my fly, but open HTML taks don't leave that telltale cold draft.

Posted by: Michael H Schneier | Oct 31, 2007 8:09:54 PM

File under never going to happen, because no state is equipped to handle the full brunt of the entire health insurance lobby coming down directly on their head.

Posted by: Dingo | Nov 1, 2007 12:47:06 AM

"1,000,000 is more then a large enough pool to run an insurance program."

Sure. If its a single payer program (but still, a poor state like NM will face dire difficulties in financing this). But if you chose a cometition based system, the resulting numbers for insurance companies won't be of a very impressive size. And size matters, because only the bigger players will have the market power to get good prices from hospitals and pharma. Not to speak of that investment into automatisation of administration needs a certain size, too. As for you example of that small company, 15 employees, that goes for self insurance: Well, there's no way this can really be cost effective. That this still might make sense for the employer only shows how ineffective the US insurance system really is. In Germany, there's no way this small company's 'insurance' could be competitive on the market (and we still have too many insurers, about 300 afaik).

Posted by: Gray | Nov 1, 2007 4:40:33 AM

Oh, btw, italics off!

Posted by: Gray | Nov 1, 2007 4:41:24 AM

Gray, up till 2-3 years ago there where 100,000s of employers under 100 lives that self-funded, it was very cost effective. At the same time people bemoan insurer profits as being excessive how can you claim self-funding which curtails these as impractile?

Your point about small insurers not having the size is a perfect example of why our market system is so effective. Small insurers and self-funded employers don't contract with providers directly they do it through PPOs. The PPOs have contracts with multiple payors. Same for adminsitration, self-funded employers higher companies like mine to process the claims. I have to compete with other TPAs to offer the best service at the lowest price or I go out of business. TPAs charge a fraction of what the large insurers do to process claims because we have to compete. If it wasn't for competition cost would be considerably higher.

Posted by: Nate O | Nov 1, 2007 1:30:50 PM

The reason that the hybrid model can't be sustained at the state level is because it's too expensive, and states can't run deficits the way the feds can.

The reason single-payer could be sustained is because it would save the state money.

Don't believe it? Go to the results of the recent modeling done in Colorado for the state's Blue Ribbon Commission for Health Care Reform.

Health Care for All Colorado submitted a generous single-payer proposal, funded by 8.1 percent income tax and 6 percent payroll tax. It saved the feds money, saved the state money, saved businesses money, saved most individuals money.

There are winners and losers in any reform, of course. Guess who the losers in the Colorado reform were...

Results from The Lewin Group's modeling are at the 208 Commission's website:

http://www.colorado.gov/208commission/

Posted by: Ave Cassandra | Nov 1, 2007 5:18:21 PM

Ave Cassandra I can't find any proposal by "Health Care for All Colorado" Are you referring to ColoradoHealth Services Program?

Posted by: Nate O | Nov 1, 2007 5:36:09 PM

Why do people think coverage of preventaive care is a good idea? If everyone is going to go get an annual check up, instead of paying insurance premium or taxes for your doctor to bill someone, then someone send them a check, said check being premium or taxes previously collected from you, why not pay it ourselves? You eliminate tons of overhead by eliminating the entire billing process. How much more efficient can you get then cutting out the insurance company, the government, the postal service and the bank.

Posted by: Nate O | Nov 1, 2007 5:42:03 PM

The comments to this entry are closed.