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Universal Insurance: A Worthy Goal, But A Miserable Climb. Vanderbilt February 12, 2009 Tom Scully. Universal Coverage— miserable??. If it was easy—it would have happened long ago! It will take until at least 2011. 5% chance in 2009—due solely to Sen. Kennedy
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February 12, 2009
-- both highly equitable behavioral disasters
-- highly responsive/flexible inequity. 47 M uninsured
-organizing the under 65 market ain’t easy?
What President has looked good here?
-Clinton? Bush 1 or 2? Carter? Nixon? Truman?
-never happen. Will never be the votes
-dumb structure; GOP is toast
- Wyden individual coverage?
GOP- Hates price fixing. Thinks Medicare and Medicaid “single payer” model is the problem.
Democrats- hate “privatization” of Medicare and Medicaid and look to government payer/contractor model for under 65 system.
NEITHER is funded—or deals with ERISA
Obama/ Baucus (similar to Daschle)
Most on left think this is way too far toward market (Waxman, Stark)
Conservative Dems and GOP think this is way too much big Government
Sen. Wyden (D-ORE) (and both TN Senators)
Correct concept. But employers, unions and insurers go nuts. Turns world upside-down. Too much too fast—not doable
-MANDATES: employers or individuals Do you randomly assign the uninsured to a plan and chase them?
-COSTS: Got $100 Billion a year—FOREVER—for me?
-ERISA- 75% of under 65 lives. Everyone ignores??
Nissan and HCA have to deal with 50 regulators? Lose control of their costs/plans?
-TAX CAP- Unions and Conservatives go nuts
Devil is in detail—and detail is NO FUN!
But there is a doable substantive middle ground
Rolling Hills: Clayton McWh; THA; Nissan, etc tasked to “find doable middle ground”
COST: Just < $100 Billion/ year
PAYING FOR THE COST:
Limit on employer deduction and employee exclusion Saves about $50-$60 Billion a year.
2) RECAPTURE $30 Billion of the $45 Billion a year of hospital subsidies. Medicare DSH; Medicare IME/GME; Medicaid DSH. If there are no uninsured, should all those subsidies continue as is?
SEE! SOMETHING FOR EVERYONE TO HATE!!!!
NO PAIN NO GAIN
LOTS OF PAIN TO GO AROUND
-Conservatives over TAX CAP; Liberals over TAX CAP
-Liberals over “not enough” in basic plan
-Politicians because it is good politics
5% is optimistic. Love Sen. Wyden (and Alexander and Corker) for trying!!