The Economics of Being Kinder and Gentler in Health Care
By UWE E. REINHARDT
Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.
In his speech accepting his party’s nomination as presidential candidate on Aug. 18, 1988, George H.W. Bush proclaimed that he wanted a “kinder and gentler nation” – kinder and gentler, I suppose, than he thought it was in 1988.
In those days, my wife and I sent out our own customized holiday cards, commenting in some way on current issues in health policy. Thus, a year after Mr. Bush was elected president, we sent out the following card:
In the late 1980s, about 35 million respondents to large nationwide surveys declared that they lacked health insurance of any kind. The comparable number now isclose to 50 million.
Then, as now, the endless “national conversation” went on and on, pondering ways to achieve truly universal health insurance coverage, a feat most other developed nations accomplished long ago.
Then, as now, news organizations and the health services research community reported on the financial and physical hardship that many low-income, uninsured Americans face when they fall ill.
And then, as now, the prices for identical health care goods and services were more than twice as high in the United States as they were – and still are – in the member nations of the Organization for Economic Cooperation and Development. It is why the supply curve of kind acts in the United States shown in the holiday card is far above the comparable curve in other countries.
The point I sought to make with that holiday card was this: Even if the desire to take care of one’s poorer or sicker fellow citizens were the same in the United States as elsewhere, a Martian might observe that fewer kind acts are bestowed on the (uninsured) poor in the United States because of the much higher price of American health care.
For all the wonderful things the United States health system has done for the American people, then, as now, it has also helped price some degree of kindness out of our souls, a side effect of their treatments that the leaders of American health care at some point must begin to contemplate.
Will study facilitate MaineCare compromise?
Described as controversial yet innovative, a contractor hired by Gov. LePage may be the key to Medicaid expansion in Maine.
The roots of a compromise to extend Medicaid health insurance coverage to 70,000 Mainers might emerge from a study being conducted by a controversial Rhode Island contractor hired this fall by Gov. Paul LePage
Whether State House Democrats and LePage desire to forge such a compromise is unknown and uncertain, as the two sides have warred over Medicaid expansion for more than a year.
LePage and Democrats in the Legislature signaled in October that they could be open to such a compromise, but since then partisan attacks over Medicaid and other issues have escalated, including over the hiring of Rhode Island contractor Gary Alexander, founder of The Alexander Group.
But while controversies have recently followed Alexander, he is also known in some circles as an innovative reformer of government programs.
Could that reputation lead to a “grand bargain” over MaineCare, Maine’s Medicaid program, granting health insurance to an additional 70,000 uninsured residents? Or will recent controversies involving
Health plan sticker shock ahead for some buyers
Counselors, who have been helping people choose policies, say many are focused only on the upfront cost, not what the insurance companies agree to pay.
By Carla K. Johnson
The Associated Press
The Associated Press
CHICAGO — As a key enrollment deadline hits Monday, many people without health insurance have been sizing up policies on the new government health care marketplace and making what seems like a logical choice: They’re picking the cheapest one.
Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they’re on the hook for most of the initial cost.
The prospect of sticker shock after Jan. 1, when those who sign up for policies now can begin getting coverage, is seen as a looming problem for a new national system that has been plagued by trouble since the new marketplaces went online in the states in October.
For those without insurance – about 15 percent of the population– “the lesson is it’s important to understand the total cost of ownership of a plan,” said Matt Eyles, a vice president of Avalere Health, a market analysis firm. “You just don’t want to look only at the premium.”
Counselors who have been helping people choose policies say many are focused only on the upfront cost, not what the insurance companies agree to pay.
“I am so deeply clueless about all of this,” acknowledged one new buyer, Adrienne Matzen, 29, an actor in Chicago who’s mostly been without insurance since she turned 21. Though she needs regular care for asthma and a thyroid condition, she says she’s looking for a low monthly premium because she makes less than $20,000 a year.
Democratic senator says Obamacare could have ‘meltdown,’ hurt party
Posted Dec. 23, 2013, at 6:41 a.m.
WASHINGTON — President Barack Obama’s healthcare law could have a “meltdown” and make it difficult for his Democratic Party to keep control of the U.S. Senate next year if ongoing problems with the program are not resolved, a Democratic senator said on Sunday.
Senator Joe Manchin of West Virginia, who has urged delaying a penalty for people who do not enroll for health insurance in 2014 under the law, told CNN that a transitional year was needed for the complex health care program, commonly known as Obamacare, to work.
“If it’s so much more expensive than what we anticipated and if the coverage is not as good as what we had, you’ve got a complete meltdown at that time,” Manchin told CNN’s “State of the Union” program.
“It falls of its own weight, if basically the cost becomes more than we can absorb, absolutely.”
The White House has been scrambling for months to control the damage from the botched Oct. 1 launch of the law, formally called the Affordable Care Act, which aimed at making sure that millions of Americans without health insurance are able to receive medical coverage.
There have been complaints from consumers about higher premiums than they previously had to pay for health insurance after their old plans were canceled because of new standards under the law, as well as lingering problems with the main web portal used to sign up for insurance, HealthCare.gov.
Manchin said Senate Democrats who are up for re-election next year are “feeling the weight” of the program’s woes and could have trouble keeping their majority in the chamber.
Republicans have been highlighting the healthcare law’s difficulties as they seek to gain the six seats they would need to win control of the 100-member Senate.
“It needs to turn around,” Manchin said of Obamacare. “I’m not going to say that I think we will lose it (the Senate). It’s going to be extremely challenging. We have some very good people who are truly there, I believe, for the right reason. They’re going to be challenged for the wrong reason.”
Single Payer Is Getting a Second Life as Obamacare Frustration Peaks
Could anger at the Obamacare rollout make Americans more receptive to a kind of Medicare-for-all system? That’s what activists are hoping—and they’re plotting a state-by-state fight.
By David Freedlander
The Daily Beast, December 10, 2013
The Daily Beast, December 10, 2013
As the rollout of Obamacare clunks forward, activists who opposed the law from the beginning say it is time to seize the moment, to tear down the current health-care edifice and start anew, especially now as frustration with the law’s implementation is reaching a peak.
These are not Tea Party activists but advocates for a single-payer health-care system who say some of the problems with the launch of the Affordable Care Act—in addition to built-in problems with the law itself—have made the American public more receptive than ever to a Medicare-for-all kind of coverage system.
On Monday, Sen. Bernie Sanders (I-VT) introduced the American Health Security Act, which would require each state to set up a single-payer health-care system and would undo the exchanges that have plagued Obamacare. Meanwhile, various state-led efforts are under way that advocates hope will sweep the country statehouse by statehouse, as soon as lawmakers see the advantage of a single-payer system. In Vermont, for example, lawmakers have set aside the financing and are already preparing to adopt a single-payer system when the federal government permits it, which according to provisions of the Affordable Care Act will be in 2015. In Massachusetts, Don Berwick, a former top Obama administration health official, is basing his campaign for governor on bringing a single-payer system to the commonwealth. And advocates in New York, Maryland, Oregon, and around the country say they see new energy around their cause.
“As the president fully understands, the rollout has been a disaster, the website has been a disaster,” said Sanders in an interview moments after his bill was introduced in the Senate. “But the truth is, even if all of those problems were corrected tomorrow and if the Affordable Care Act did all that it was supposed to do, it would be only a modest step forward to dealing with the dysfunction of the American health-care system. When you have a lot of complications, it is an opportunity for insurance companies and drug companies and medical equipment suppliers to make billions and billions of profits rather than to see our money go into health care and making people well.”
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