Friday, 12 June 2009

The Fierce Urgency of Healthcare Reform Now

This past weekend, Organizing for America kicked off a massive public effort in support of health care reform. I had hoped to host an event in support of the Administration's important work here, but I was unable because (as you have learned in my last post) I was suffering from poor health. ("My name is Irony, king of kings. Look upon my works ye mighty and despair.")

Of course, were I in the US right now I would not have access to medical insurance. And I don't just mean that I would have to pay a lot for it (though I would) but that I could not get coverage at all - this isn't the first time my back has gone out, so any US insurer would consider this a pre-existing condition and my coverage would be denied. Since I took voluntary redundancy from my full time job back in February and started working free lance, I've been counting my blessings that I at least will never go bankrupt due to a health crisis.

But I wouldn't suggest that the US adopt a UK style National Health System - the NHS does provide universal coverage but hasn't been able to match other countries in terms of quality of care (although, the UK system does consistently beat the US one on most measures of health outcomes - at half the price! Bargain!).

Instead, I'd like to see a system that focusses heavily on reducing costs and achieving virtually if not completely universal access to health COVERAGE - who does delivery of care doesn't have to change at all.

Our for-profit health system has made care in the US more expensive than anywhere else in the world WITHOUT a compensating rise in quality (read this excellent Atul Gawande article in the New Yorker for a better perspective on how and why this is so).

And most Americans now agree that something fundamental has to change - this is a big change from the 1990's and means this is the best chance we've had to solve the problem in many a year.

I think it's pretty clear something is going to happen in this area. But in legislation, as in needlepoint, the devil is in the details.

The bulk of the shouting is likely to be around what is constantly referred to as "the public option." You may have heard this phrase bandied about and perhaps, like me, you had a vague sense what this was all about but were unsure specifically what it meant or how important it might be.

Well, as best I can figure out, the short version is this - healthcare reform has two basic goals:

1) Reducing costs.
2) Ensuring full universal (or near-universal) coverage.

Both are essential, and doing the former will not only greatly reduce the burden on those who currently have care, but will also make it much easier to achieve the latter.

Although the government could simply regulate strict conditions for existing private insurers (setting prices, for instance) this is a pretty market-unfriendly practice and may in fact ultimately result in not achieving the full measure of cost savings that would potentially be achievable. A better solution is to create market conditions that put strong pressure on private sector firms to be very innovative in finding cost savings as well as providing low cost and appealing options for those who are shut out of the private system.

That's what the inclusion of a public plan will do. Because a national public plan can negotiate lower prices with providers it has a big advantage in finding cost savings.

There are lots of different ways of delivering this, however. Check out this hugely helpful Marc Ambinder article for more info:

For most advocates, the purpose of a public option is to create an "ideal" health insurance plan that can experiment, can decide to pay doctors what it wants, can use what Rep. Henry Waxman has called "creative tension" to compete with private plans, and one that will ultimately serve as a mean toward which all the private plans move. A strong public plan would force private plans to negotiate lower rates with doctors and hospitals, which would reduce health care costs. A "weak" public plan would provide some competitive pressure, but would not be big enough to force the private plans to drastically change their models. Between these two ends, there are many options. Here are five:

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