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Politics : View from the Center and Left -- Ignore unavailable to you. Want to Upgrade?

To: Cogito who wrote (130411)	2/8/2010 9:16:26 AM
From: Lane3	Respond to of 541957

I thought we were talking about just implementing the idea of national plans. Nobody mentioned that we would be adding new federal regulations, too, nor what they would be. Once again, we're working from a different set of assumptions. I, too, thought we were talking about national plans. And trying to keep to one topic at a time. But you mentioned the problem of dropping and excluding people as though it were a given that that practice would continue, an apparent assumption on your part. By asking the question I was trying to suggest that it's a separate matter and outside the scope of national plans. Plus considering that you might see it otherwise and curious about how that might be. [Even though it is outside the scope of national plans, I would think, as I have posted before, that we would do something about dropping and excluding people. I do not think that federal regulation would be needed to do that. Federal law, perhaps, but not regulation. My default is no federal regulation of health care insurance. Perhaps something narrow that absolutely can't be done any other way but definitely not large scale.] Just in health insurance. I think it's an area where experiences in many other countries have shown that mainstreaming works. I have lots of questions about the viability of mainstreaming. We can see lots of other arenas where it doesn't work or works poorly or is very costly. A limited amount of it is light noise in the system, barely perceptible. But there comes a point of inevitable breakdown. My systems experience has always involved making a determination of where that threshold is, that is, when a separate subsystem is needed for outliers. I don't think the current proposals are cognizant of that. It might be ignorance. It might be feel-good. I think it's imperative that we at least consider the trade-offs. Sure, mainstreaming works well enough in other systems. In the single-payer ones it's inevitable and has no import because there's no opportunity for separate subsystems. But the proposals we have on the table are not single-payer; therefore, subsystems are possible. My instinct is that a separate subsystem would probably work better in our environment. To that end, I have already advocated a government system for those affected by exclusions although with a higher threshold. But I think it should be modeled and decided more thoughtfully than it has been. People seem perfectly content in this country to let very wealthy people live in nicer homes... You could be right about that. I just don't know. Given that other countries such as the UK and Canada have already experimented with disallowing (and criminalizing) medical care outside their single-payer systems and given the propensity in some progressive quarters to rail against inequality and favor equality of results I think there's risk. There would surely be voices complaining about the inequality. Even now we hear complaints about the rich getting better care. Whether those voices would prevail, perhaps not, but the potential is something to ponder, seems to me. No such backlash has occurred with Medicare, has it? For one thing, Medicare patients are to a large extent "other." If Medicare covered everyone, there might be a different reaction. For another, Medicare supplementation is mostly about policies to cover the co-insurance, not about additional benefits. Those with straight Medicare and those with supplements get pretty much the same medical services. The difference is mainly in what they pay out of pocket. If, however, the better off started buying policies to cover what Medicare rationed, which would be more likely to occur with a different cohort, say preventive care or fancy tests or more aggressive treatment or longer hospital stays, I can see the possibility of a backlash. I am trained to consider everything.