Here’s a synopsis of the initial reactions from the health blogosphere to Sen. Ron Wyden’s (D OR) Healthy Americans Act.
Ezra Klein notes that insurance companies will have to compete on quality and low cost instead of medical underwriting and risk selection. I’d agree but note that HAA should push health plans to take all those dollars they have been investing in risk selection and broker commissions and invest them in care management. Health plans talk a lot about managing care, but few are really doing anything innovative or productive.
Matt Singer of Left in the West opines that Wyden’s plan is not perfect, but as it dramatically reduces the number of uninsured, it eliminates many of the current problems in health care – cost shifting and cerry-picking (underwriting) among them.
Matt Holt thinks Wyden’s a few years too early with his proposal, and also is not sure how the plan will actually reduce health care expenses. My take? Wyden’s approach is to let the health plans figure out how to manage care and cost, thereby avoiding the “Harry and Louise” problem – the public really does not want government controlling health care.
If you really can’t get enough of this, head over to the DailyKos, where deaniac, a single payer true believer, thinks that Wyden’s plan solves the biggest problem (universal coverage) first. Not d’s ideal solution, but way way better than the alternative (which is no reform at all). D also notes that the support from the SEIU is huge, as the union has more members working in health care than any other group.
Meanwhile, at least one blog describes this as socialized medicine, a repeat of Hillarycare, and, (yes, this is a quote “when everyone believes in something it’s communism”). And says after two years of the Wyden program America will collapse. No reasons for the implosion; perhaps the poster is a really smart geologist who knows something we don’t about earthquake predictions or has figured out that the center of the earth really is hollow and we’re slipping into it. Hey, if they’re not willing to be serious and thoughtful, why should I?
A much more thoughtful criticism is found at Hank Stern’s Insureblog. Hank has three problems with the Senator’s proposal and discussion thereof: it’s reliance on community rating wherein all members get charged the same premium, and (Hank thinks) that the emphasis on prevention will not help down costs. Hank also interpreted Wyden’s comments on cost-shifting to mean the program will solve the problem of cost shifting from private sector to the government; I didn’t hear that (from private to government cost shift), which is why it’s good there were a bunch of ears in attendance.
Hank’s a good man and a sharp guy, but I’m absolutely fine with community rating. That’s what insurance is; spreading the risk among a large population. And prevention with teeth will help reduce health care costs.
There’s a few questions yet to be answered; among my concerns is the plan’s full coverage once the member’s out of pocket costs hit $4000. As I’ve noted before, most health care dollars are spent by folks with chronic conditions. And once they blow thru their deductible they don’t care what it costs. If “consumerism” is ever going to be anything but a nice idea, we need to make sure the folks who spend the most have some financial skin in the game.
I posed that question, and when I hear back from Wyden’s staff I’ll update.