Path to Compromise on Health Care

Epiphany almost happens when you least expect it.  Perhaps that is because the mind is most clear at such times.

The paper today brought together thoughts that I have expressed before with a new insight into the dangers of politicizing health care, which is what a single payer plan would do.  The danger is that once you have a national health care plan, taxpayers want their Congressperson to fix things.  I know this to be true because as a Congressional Intern I saw how much time the office spent helping constituents fix relationships with the VA, Social Security and other aspects of the government.  Health care would exacerbate this particularly if the Cost Control Panel did anything serious to control end of life expenditures in a systematic way.  The latter needs to be done but perhaps it is better to let the insurance companies take the blame.

David Brooks column was part of this process and is worth reading for its own merits.

Link to David's Column

Previously I had read that both Democrats and Republicans have supported the concept of Federal support to the states to cover health care costs at various times.  Also, someone pointed out that what the Democrats do not want for Medicare, they do want for the <65 population and what the Republicans do not want for the <65 population, they do want for Medicare.  Somewhere in there should be ground for compromise and a path forward.

Let me review what I believe the path forward for health care needs to cover.

Costs must be controlled.  There are many aspects to this.  Fair and honest management of end of life care is an important part of that but also a third rail politically.  Chronic conditions need to be managed outside of emergency rooms in an insured manner.  Fee for Services incentives need to be altered to incentivize package pricing and control of costs.  Competition is part of this.

The uninsured need to have insurance so their expense does not enter the insured's expenditures through cost allocation processes.  A critical part of this is not allowing insurance companies to exclude people because of pre-existing conditions.

A base level of coverage must be mandated by regulation for reasons of fairness and to limit price competition by eliminating aspects of base level coverage.  Many people cannot understand the differences between such coverages and would not spend the money for services they need.  In other words, when they need the service they would enter the system as uninsured and the costs would reenter the system.  People need to pay for the insurance they need.

Separate Health Insurance from employment. Put everyone into the individual insurance market.

Allow Insurance companies to compete across state lines.  (Although this may be a function of state regulations, not federal),

Limit malpractice awards.

Whatever the Supreme Court decides about the Affordable Health Care Act, the evolution of health care in this country is not complete until costs are controlled.  On that point both parties agree and the solution is not in what we had before the Affordable Health Care Act nor does it lay in abandoning the good things in the Affordable Health Care Act.