Healthcare Reform Thread

[Kuciwalker]

If it's neither, why did he bother to mention it in the first place?

[Ramo]

I don't know. Maybe he was comparing it single payer (i.e. Conyer's bill), which he referred to earlier in the post. Maybe because he's not the best writer in the world. But you know, there are sources to find this information beside that single blog post. I'd like to see some actual evidence.

But by your logic, Olympia Snowe ends up somewhere between Ted Kennedy and Bernie Sanders in terms of legislation that they're pushing.

[KrazyHorse]

Ramo: according to you the only difference between weak and strong is whether or not negotiations are conducted in unison with existing Medicare coverage or not?

By the way, your claim about "smaller risk pools" is a red herring. Current medicare recipients receive the vast majority of their benefits premium-free (medicare part A) therefore they are not "choosing" to join any risk pool; by subsidizing to such an extent the government is removing all choice from the matter. The people who choose to join Medicare under the new plan would form their own risk pool no matter what.

EDIT: the only risk pool the government could throw the new people in with is:

a) The people who are ineligible for the subsidy to Part A
b) A risk pool for the other medicare sections

[Ramo]

That's right.

I was talking about the co-ops. They'd be much smaller risk pools than a national plan.

[KrazyHorse]

health care co-ops as a substitute for the private plan, which would resemble the weak plan in certain ways (i.e. lowering bargaining ability, smaller risk pools)

[KrazyHorse]

By the way, you do realize that the adverse selection problem is extreme for any optional plan, right? Most states have a "last ditch option" for the uninsured. Modulo negotiation power with providers these are pretty good estimators for what an optional plan would cost. And it's not pretty. Only the sickest will choose to join.

[Ramo]

The idea is that you still have a relatively balkanized health insurance market with co-ops. Less pooling. This is a distinct issue from not piggybacking on Medicare disbursment (10% higher, specifically).

[KrazyHorse]

Ramo, when you say that the coops share certain features with the "weak" plan and then list "smaller risk pools" as one of these features, you are saying that the "weak plan" has smaller risk pools than the strong plan.

Be careful.

[Ramo]

By the way, you do realize that the adverse selection problem is extreme for any optional plan, right? Most states have a "last ditch option" for the uninsured. Modulo negotiation power with providers these are pretty good estimators for what an optional plan would cost. And it's not pretty. Only the sickest will choose to join.

Yep. Part of the reform is putting in no discrimination in the private market, and limiting the price range of premiums. Policing that will be difficult.

I'd prefer to see a taxpayer funded single payer for primary care, but that obviously isn't the realistic.

[Ramo]

Ramo, when you say that the coops share certain features with the "weak" plan and then list "smaller risk pools" as one of these features, you are saying that the "weak plan" has smaller risk pools than the strong plan.

Be careful.

True, I wasn't too clear. Some of the weak plans were limited in size to specific jurisdictions, i.e. states. So you have a strong similarity to that subset.

The generic "weak plan" is outdated. The options are currently (in order by likelyhood) co-op, strong, and trigger.

[Kuciwalker]

I don't know. Maybe he was comparing it single payer (i.e. Conyer's bill), which he referred to earlier in the post. Maybe because he's not the best writer in the world. But you know, there are sources to find this information beside that single blog post. I'd like to see some actual evidence.

But by your logic, Olympia Snowe ends up somewhere between Ted Kennedy and Bernie Sanders in terms of legislation that they're pushing.

No, because it's possible he mentioned it to contrast with only one of them, and "strong plan" seems like the more plausible of the two. It's not plausible that he wasn't using it as contrast at all.

[KrazyHorse]

I think that my preferred plan would be for:

1) National, non-optional catastrophic coverage along with coverage for certain public health measures, preventative measures (e.g. biannual checkups) and child coverage. Catastrophic coverage would provide only low-cost/high effectiveness treatments.

2) Means-tested aid for a small percentage of the population (US medicaid?) which covers additional non-catastrophic services (twisted ankles, sniffles etc)

1&2 taxpayer funded, with user fees (possibly no user fees for 2, or reduced user fees)

3) Employer provided (I still can't figure out a better way to reduce the adverse selection problem) coverage for more advanced treatments and non-catastrophic injuries. Force insurance companies to accept pooled coverage of all companies with greater than (say) 5 full-time employees (or equivalent in part-time covered employees; this requirement is to prevent the gaming of the system by individuals who form one-person companies). Part (1) covers hypothetical costs of basic treatment, part (3) pays the costs on top of this. Employers pay premiums which, if continued through the lifetime of employees, would cover lifetime coverage. In other words, they pay more than it would cost to simply cover their workforce. This is because we want:

4) Retirees with qualifying amounts of time worked can continue their previous employer-based coverage at the same price their employer was paying. i.e. retirement COBRA. Payments should probably be indexed to CPI, but that's a bit of a detail.

[Ramo]

It's not plausible that he wasn't using it as contrast at all.

Yes. It is entirely plausible.

So, your theory is that Klein is so deliberate with his language that his description of the weak plan implicitly describes something else. And he went ahead to describe the two other options that were on the table at the time, and failed to thoroughly describe one of them - despite his masterful use of the English language. But we don't know which one, for sure. And we have to make an assumption here because the only person who follows Ted Kennedy's public announcements is a single journalist, in a single blog post. Ok, dude.

[Kuciwalker]

Why would you both to mention one plan isn't taxpayer funded if none of them are?

[Ramo]

I think that my preferred plan would be for:

1) National, non-optional catastrophic coverage along with coverage for certain public health measures, preventative measures (e.g. biannual checkups) and child coverage. Catastrophic coverage would provide only low-cost/high effectiveness treatments.

2) Means-tested aid for a small percentage of the population (US medicaid?) which covers additional non-catastrophic services (twisted ankles, sniffles etc)

1&2 taxpayer funded, with user fees (possibly no user fees for 2, or reduced user fees)

3) Employer provided (I still can't figure out a better way to reduce the adverse selection problem) coverage for more advanced treatments and non-catastrophic injuries. Force insurance companies to accept pooled coverage of all companies with greater than (say) 5 full-time employees (or equivalent in part-time covered employees; this requirement is to prevent the gaming of the system by individuals who form one-person companies). Part (1) covers hypothetical costs of basic treatment, part (3) pays the costs on top of this. Employers pay premiums which, if continued through the lifetime of employees, would cover lifetime coverage. In other words, they pay more than it would cost to simply cover their workforce. This is because we want:

4) Retirees with qualifying amounts of time worked can continue their previous employer-based coverage at the same price their employer was paying. i.e. retirement COBRA. Payments should probably be indexed to CPI, but that's a bit of a detail.

Why means-test GP visits (assuming you have user fees)?