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Health Care: Devilish Details

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Initially promised as a “bridge” between moderate and liberal Democrats, majority leader Reid’s plan to extend Medicare benefits to those 55 and older who cannot obtain private insurance is running into resistance. From Politico:

Senate moderates who are the linchpin to passing a health care reform bill raised fresh worries Thursday about a proposed Medicare expansion, complicating Majority Leader Harry Reid’s hopes of putting together a filibuster-proof majority for the legislation in the coming days.

Two days ago, the Medicare proposal appeared to be the elusive bridge between liberals, who were being forced to give up a public health insurance option, and moderates, who said they couldn’t vote for a bill that included one.

While Republicans have been completely locked out of the process, moderate Democrats are concerned that none of the details have been provided. Senator Reid is evidently waiting for cost estimates from the CBO before releasing the details (Politico):

Reid will not release details — even to senators — until he receives the CBO analysis, which isn’t expected until early next week. At that point, Reid has less than two weeks to tweak the plan if the price tag is too high, brief his caucus, lock down the votes and clear a series of procedural hurdles for final passage.

Republicans worry that the plan is simply another step in the direction of a single payer system as the Wall Street Journal editorialized. The fear is that no or low cost coverage in Medicare quickly eliminates competition and starves the private sector plans.

Polling shows support for the Democrat’s plan is eroding, with CNN’s poll showing only 36% supporting, a 10 point drop from the same question a month ago. Fox pegs the favorable number at 34%, noting that the all-important independent voter matches that number precisely, with 66% opposed to it (Democrats favor the plan by 66%, but only 22% of Republicans favor it).

Moderate Mort Kondracke explains why the public remains skeptical:

The White House and liberal think tanks insist that health care reform will lower costs, but the public isn’t buying it – and for good reasons.

Practically every aspect of the bills Democrats are considering – from covering the uninsured to taxes on providers, insurance reforms and Medicare cuts – will result in higher premiums for those with insurance.

And unless Congress is willing to impose stricter cost controls than presently contemplated, many experts think there’s little chance of “bending the curve” of national health outlays or premiums.

Politics abhors a vacuum, and speculation rushes to fill it. By drafting the legislation in the proverbial smoke-filled back room, Reid has increased uncertainty. Kondracke, who supports the idea of a private industry option to provide health insurance to everyone, notes the support in polls for the general concept of providing health insurance availability:

The Quinnipiac poll, like most others, shows that the public favors – 56 percent to 38 percent – “giving people the option of being covered by a government health insurance plan that would compete with private plans.”

My guess is that the words “option” and “compete” elevate support for government-run health insurance, but in any event, it’s dead in the Senate. Negotiators have substituted a system like the Federal Employees Health Benefit Program that relies on negotiation with and competition between private companies.

That should be the design for the whole of U.S. health care reform, modeled on successful programs in Switzerland and Holland, and Republicans would be smart to propose it.

The Swiss system has been recommended as a model for the US. It requires participation, and the basic coverage must be offered on a non-profit basis. Share of costs can be chosen by the participant with corresponding premiums, with a maximum out of pocket cost at 8% of income (government subsidies make up the difference for the poor). Residents are able to buy additional insurance products if they wish, but basic medical care and hospitalization are covered by the plan. The plans are managed by each canton (state), which meshes nicely with our federalist system. The New York Times reported on it in September of this year:

“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.

“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”

Cross posted to FrankHagan.com