The Amazing Maze of US Health Care

There is nothing simple about our health care maze.  Fixing it is not easy.

I prefer to look for the simple.  The complexity will evolve naturally.

Congress prefers to start with the complex and make it more so.

Spreading the medical risk

There  are two major challenges to fixing the customer side of the health care mess – spreading the medical risk and spreading the financial costs.

Spreading medical risk requires that everyone be in the system.  That spreads medical risk evenly between the sick and the healthy.  That can be accomplished by a system of automatic eligibility or a system of required enrollment.

Automatic eligibility describes a single payer system.  All citizens are enrolled by virtue of their citizenship.  To draw from known models, automatic enrollment describes Part A Medicare, Department of Defense medicine, and to a lesser extent, the Veterans Administration.

Funding for those programs is separate from enrollment and may or may not rely on direct participant financing.

A system of mandatory enrollment implies a system of mandatory participant financing.  That is where we bump into the second challenge.

Spreading the financial costs

How do we transfer money from those who have it to those who need it? Read the rest of this entry »

By NAFTALI BENDAVID

Some of Senate Majority Leader Harry Reid’s colleagues were surprised by his decision this week to include a government-run health-care plan in the Democrats’ bill.

But the mathematics of the Senate suggest the motives for the Nevada Democrat’s gamble: While a handful of Democratic moderates don’t like the so-called public option, the liberals who support it easily outnumber them — and at least some of them warned Mr. Reid they would oppose a bill that didn’t include the option.

Reid’s Math: Liberal Fans Exceed Public-Plan Foes – WSJ.com

By JULIE HIRSCHFELD DAVIS (AP) –10/28/09

WASHINGTON — Does the AMA matter in the health care debate? Congress is beginning to have its doubts, despite the medical association’s deep pockets and platoons of lobbyists.

It’s lost its principles, some lawmakers and physicians say. Perhaps more damaging: It can’t produce votes.

After a humiliating defeat in the Senate, the venerable American Medical Association faces a revolt from both its member doctors and one-time political allies as it struggles to influence an overhaul of the nation’s health system.

The Associated Press: THE INFLUENCE GAME: Doctors’ lobby in tricky spot

Fittingly close to Halloween, Senate Majority Leader Harry Reid (D-Nev.) resurrected the possibility of a government-run insurance option when he announced on October 26 that he intends to include in the Senate bill a public plan with the option for states to opt out.

The move was not a surprise to EBA’s health reform panelists who have been reading the tea leaves in the past few weeks. “Once Sen. Snowe talked about the opt-out in a favorable manner, I thought that this would be in the Senate bill. It also looks like the Senate liberals, like Sen. Rockefeller, can live with the opt-out,” says Bill Sweetnam, principle with Washington, D.C.’s Groom Law Group.

The public option: It’s baaack – Articles – Employee Benefit Adviser

Editorial– chicagotribune.com

Democrats in the U.S. House and Senate have spent the spring, summer and fall grappling with how to fix the health care system. They’re still trying to craft a bill they can sell to Americans — or even explain in plain English.
And the Republicans? Well, as the minority party, they’re mainly on the sidelines. They’ve become the party of “no,” sniping at every Democratic health care reform idea without promoting any of their own. Right?
Not entirely.

A GOP health plan — chicagotribune.com