Thursday, July 30, 2009

Health Care Thursday

ThinkFast: July 30, 2009
In a statement released yesterday, Sen. Mike Enzi (R-WY) said that, to get a bipartisan bill, Democrats have to agree to his demands. Enzi said he wants “commitments from Senator Reid and Speaker Pelosi, as well as the Administration, that the bipartisan agreements reached in the Finance Committee will survive in a final bill that goes to the President.”
Yglesias: The Popularity of Government-Run Health Insurance

The flipside of Americans’ loss-aversion about their current health coverage, discussed below, is that those people who have the opportunity to benefit from government-run health insurance tend to be much more loss-averse than those experiencing private sector insurance. The United States actually contains an interesting experiment in this issue because Americans over the age of 65 suddenly transition into the Canadian-style program known as Medicare (conveniently, Canada’s national health insurance program is also called “Medicare”). About a month ago Mark Blumenthal pointed out that customer satisfaction is much higher inside Medicare:


More importantly, the higher scores for Medicare are based on perceptions of better access to care. More than two thirds (70 percent) of traditional Medicare enrollees say they “always” get access to needed care (appointments with specialists or other necessary tests and treatment), compared with 63 percent in Medicare managed care plans and only 51 percent of those with private insurance.

As Ezra Klein noted yesterday you see the same thing internationally:


As you can see here, there are a variety of appealing models. People like Canada’s Medicare for All approach, just as people here like Medicare. What the Dutch do is quite different, is somewhat more appealing to the wonk’s sensibility, and is also quite popular. The UK approach which is, again, totally different and really does feature the dread “rationing” is also really popular. Nothing can quite beat the American system for producing widespread dissatisfaction.

Ezra Klein: Eight Reasons to Pass Health-Care Reform

Barack Obama is going on the road today with a retooled pitch for health-care reform. In particular, he's emphasizing how reform will help the rest of us. To dramatize this, the White House has come up with the eight guarantees that will be written into health care bill the president signs:

* No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

* No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

* No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

* No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

* No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

* Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

* Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

These protections would help a lot of people. Or, to be more precise about it, these protections will keep a lot of people from receiving a terrible blow when they're most vulnerable.

Yglesias: Obama and the Institutions

Mark Schmitt has a column out smartly arguing that “Obama’s apparent belief that existing institutions can do what they have so far failed to do — and his resistance to creating new ones — is emerging as an odd, surprising theme of his presidency.” I’m much less sure I agree with Schmitt’s conclusion that this might be a good thing:

It takes some discipline to understand that organizational culture, not organizational structure, determines success or failure. And it takes a lot of patience to wait for an organizational culture to turn around and resist the temptation to add a commission here, a new agency there. Obama’s organizational discipline was the hallmark of his campaign, and we can only hope that his unyielding insistence that “our existing democratic institutions are strong enough” will eventually make them so.

It’s not so much that I do think we need “a commission here, a new agency there” but have been taken aback by the extent to which the administration appears not to believe that substantive and procedural reforms need to go hand-in-hand, especially given that Obama has a substantial background as a political reformer.

It seems to me that presidents’ most lasting achievements are often structural/institutional in nature. We don’t have a lot of New Deal initiatives still in place, but we definitely do have a modern administrative state. Ronald Reagan didn’t just cut taxes, he indexed tax brackets to inflation and forever changed the politics of taxes. There are a lot of problems with American political institutions. Many of these problems aren’t amenable to immediate and total amelioration. But things could be better. And it’s important for the one person in the planet capable of claiming a general mandate from the citizens of the country to push things in the right direction.

Yglesias: As Usual, Public Wants Lower Deficit Without Cutting Spending or Raising Taxes

According to the latest New York Times poll, the public continues to be ill-informed and hypocritical:


Most Americans continue to want the federal government to focus on reducing the budget deficit rather than spending money to stimulate the national economy, a new New York Times/CBS News poll finds. Yet at the same time, most oppose some proposed solutions for decreasing it.

Fifty-six percent of respondents said that they were not willing to pay more in taxes in order to reduce the deficit, and nearly as many said they were not willing for the government to provide fewer services in areas such as health care, education and defense spending.

This is why I think shrewd politicians don’t spend too much time sweating the details of public opinion about issues. What really matters in recent polling is that as Barack Obama is subject to the usual partisan attacks, his polling honeymoon has vanished and if the economic situation continues to deteriorate he’ll get even less popular. When vulnerable members of congress push the health care vote back into the fall, they’re almost certainly pushing it into a time period during which opinion will be fairly anti-Obama.

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