Health Reform, Markets, Bipartisanship
Published on July 29th, 2009 @ 04:42:34 pm , using 437 words
This am post in WaPo from Ezra Klein needs to be in the mix for health reform. A bridge system makes all kinds of sense. And and a health insurance exchange has recognizable market features, which seems to be a helpful notion at this time. And a bipartisanship is needed, if possible, or the Reps. will cry foul in the next election, especially if the economy is still struggling. Incidentally, Obama at AARP town hall meeting yesterday reminded participants that Medicare is a government-run program and works pretty well. The battle in this situation is of great moment, and one can see the outlines of ideas that could begin the necessary changes. BP
The answer that reformers have come up with is that you don't change the current system. In the short term, you strengthen it with subsidies and regulations on insurers. You make it kinder and gentler. But you also build the beginnings of a new, better health-care system off to the side. You let it demonstrate its efficiencies and improvements. You let the lure of lower costs and higher quality persuade Americans to migrate over of their own accord.
This is what the health insurance exchange is designed to do. It is arguably the single most important element of health-care reform, because it is the bridge between the system we have and the system we want. But amid the clamor over public insurance options -- which, incidentally, would be housed on the exchange -- and employer tax exclusions and all the other points of controversy, the health insurance exchange is hardly being discussed. And there are signs that it, and thus the long-term promise of reform, might be in danger.
Compared with the crazy-quilt system we have now, the idea behind the health insurance exchange is almost weirdly simple: It's a single market, structured for consumer convenience, in which you choose between the products of competing health insurers (both public and private). This is not a new idea. It is how we buy everything from books to socks to soup. Everything, that is, except health insurance. The benefits of reversing that bit of accidental exceptionalism are obvious to anyone who has ever stepped inside a Target: Consumers will benefit from more choice, from direct competition between insurance providers hungry for their business, from regulations meant to protect them from deceptive products, from efficiencies of scale, and from the sort of purchasing power that only a large base of customers can provide. They will benefit, in other words, from an actual, working market -- something health insurers have managed to avoid for far too long.
Ezra Klein
WaPo
29July09
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As a trained community organizer, President Obama should know the first rule of change: Change is a math formula. The formula reads, "Change happens when the cost of the status quo is greater than the risk of change." Community organizers know that change only comes when the status quo has become so costly, so untenable, so unworkable that change is a welcome relief, despite its inherent risks.
But so far, except for a few brief references in press conferences and speeches, the president has shied away from raising the high cost of the status quo. All too quickly he brushes by the fact that the current health care system is a disaster, both economically and humanly. It drives individuals into bankruptcy. It puts American companies at a competitive disadvantage. It represents a huge drain on our national economy. And it doesn't even deliver particularly good results.
Our health care system eats up roughly 16 percent of our GDP, and yet America's standing when it comes to over-all child well-being is no better than 20th in the world. In human terms, newspapers and TV reports are filled with documented cases of lives destroyed or lost due to the hit-or-miss nature of the existing health care system.
A case in point: In 2007 Mary Otto of The Washington Post told the tragic story of a 12 year-old boy named Deamonte Driver of Prince George's County, Maryland, who died of a toothache--a toothache!--because the abcesses in his mouth spread to his brain and killed him. A simple $80 tooth extraction could have saved his life. But his mother wasn't insured, the family had lost its Medicaid coverage, and finding a dentist who'd do the work that the family could afford turned out to be too much.
Change is a math formula. The status quo is unworkable. It is a crisis. It costs too much and delivers too little. It is an economic drain. It is a human disgrace. That message, delivered by President Obama over and over and over is what has been missing. The way to get people to accept--even embrace--the risk of change is first to drive up the high cost of the status quo. If you get the message right, the politics will follow.
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