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Half of Americans Live Where Population Is Too Low for Competition

Half of Americans Live Where Population Is Too Low for Competition. A town’s only hospital will not compete with itself. Source: NEJM 1993;328:148. Proposed by Richard Nixon in 1971 to block Edward Kennedy’s NHI proposal. “Mandate” Model for Reform.

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Half of Americans Live Where Population Is Too Low for Competition

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  1. Half of Americans Live Where Population Is Too Low for Competition A town’s only hospital will not compete with itself Source: NEJM 1993;328:148

  2. Proposed by Richard Nixon in 1971 to block Edward Kennedy’s NHI proposal “Mandate” Model for Reform

  3. Government uses its coercive power to make people buy private insurance. “Mandate” Model for Reform

  4. “Mandate” Model for Reform • Expanded Medicaid-like program • Free for poor • Subsidies for low income • Buy-in without subsidy for others • Employer Mandate +/- Individuals • Managed Care / Care Management

  5. What’s New Since Nixon? • Individual mandate • Promised cost savings through computerization • Government Brokers Private Coverage, e.g. FEHBP

  6. Massachusetts 2006 “Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced. Gov. Romney.” “The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.” Sources: Wall Street Journal 4/11/06 and New York Times 4/5/06.

  7. Massachusetts Health ReformNew Coverage • < Poverty -Medicaid HMO • 100% - 300% poverty - Partial subsidy • > 300% poverty – Buy Your Own

  8. Crimes and Punishments in Massachusetts

  9. Massachusetts: Required Coverage(Income > $30k) • Premium: $4,080 Annually (56 year old) • $2000 deductible • 20% co-insurance AFTER deductible is reached

  10. Massachusetts 1988 “I am very proud of the fact that Massachusetts will be the first state in the country to enact universal health insurance.” Gov. Dukakis` “Massachusetts last week ventured where no state has gone before: it guaranteed health insurance for every resident.” Sources: New York Times 4/14/88 and 4/26/88

  11. Oregon 1992 “Today our dreams of providing effective and affordable health care to all Oregonians has come true.” Gov. Roberts “The most far-reaching health care reform in the nation.” Sources:Washington Post 6/9/92 and 3/20/`93

  12. Tennessee 1992 “The most radical health care plan in America.” “Tennessee will cover at least 95% of its citizens with health insurance by the end of 1994.” Gov. Ned McWherter Sources: Federal & State Insurance Week 4/12/93; and NY Times 9/16/94

  13. Vermont 1992 “This is an incredibly exciting moment that should make all Vermonters proud.” Gov. Dean “Governor Howard Dean, the only governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal healthcare by 1995.” Source: New York Times 4/12/92

  14. Minnesota 1992/1993 “Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it . . . the first complete reform proposal in the U.S.” “Minnesota is about to embark on a plan to solve the health-insurance crisis that could hold lessons for other states and the nation.” Sources: New York Times 4/19/92; and Richard Reece, Medical World News 7/1/92.

  15. Washington 1993 Washington state “passed one of the most aggressive health care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state . . . .” Source: New York Times 5/2/93

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