What Health Reform Will We Get?

I’m getting a lot of questions from family and friends about health reform. This post repeats them and provides my thoughts.

Will health reform happen? I think the chances are good that congress will pass something that the Democrats and Obama will call health reform. That says nothing about the precise form it will take.

Will we get universal coverage? If we get any health reform I think it is likely that it will include an individual mandate so we will achieve something like universal coverage.

Will health spending be controlled? Those who ask this are really wondering if we will manage to change the rate of increase in health expenditures. I do not think we will achieve any significant long-term change in the rate of increase in health spending. I think we will achieve some one-time savings (shifts in the level of spending) but true cost control will require steps that are unpalatable to a majority of Americans and to key special interest groups. In particular providers need to get paid in a maner that does not encourage them to provide high-cost, low-benefit services. Maybe in a few years or a decade we’ll finally implement the necessary steps to reduce the rate of increase in health care costs.

Will premiums reduce? I think premiums for some individuals will come down. Low income individuals will receive subsidies. The non-group (non-employer) market will be reformed in a way to make insurance less expensive and more accessible. I do not expect that most Americans (those with employer coverage) will see a long-term change in the rate of increase in premiums.

Will there be a public plan? I expect there to be something that the Democrats and Obama can call a public plan. I do not expect it to be a plan that has sufficient power to drive down prices. That’s just too controversial.

Will employer-provided coverage be taxed? I expect it to be taxed, at least partially. Coverage expansion simply requires too much money to fully maintain the favorable tax treatment of employer-provided insurance.

What is the right way to reform the system?Hah! That’s a good question. It cannot be answered so simply. It depends on the goals. If controlling cost is the only goal then a single-payer, Medicare for all type plan is the right thing to do. If preserving choice and allowing people to keep the insurance they have then something that builds on the current employer-based system is the right thing to do. Since reform is not driven by what is “right” but by what is possible I don’t think it is terribly valuable to spend a lot of time thinking about what is “right.”

Where can I learn more? This is the best question. One source is my interview on OneMintthat links to some other articles. However, I think there are better sources of information on health reform than me. I’m not as plugged in to congress as other bloggers are. I don’t follow every nuance of every proposed bill and amendment. To learn more see Kaiser Health News and the Kaiser Health Reform Gateway. To stay up to date become a regular reader of Ezra Klein’s blog at the Washington Post and Jonathan Cohn’s blog at The New Republic.

If you have other questions about health reform (or anything), just ask. I’ll do my best to answer if I can.

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