How should Obama reform health care?

[Zeno Swijtink]

ANNALS OF PUBLIC POLICY
GETTING THERE FROM HERE
How should Obama reform health care?
by Atul Gawande
The New Yorker
JANUARY 26, 2009





Annals of Public Policy: Getting There from Here: Reporting & Essays: The New Yorker

[Tars]

Nice survey article Zenos. I was particularly interested in the Massachusetts approach:

Massachusetts, where I live and work, recently became the first state to adopt a system of universal health coverage for its residents. It didn’t organize a government takeover of the state’s hospitals or insurance companies, or force people into a new system of state-run clinics. It built on what existed. On July 1, 2007, the state began offering an online choice of four private insurance plans for people without health coverage. The cost is zero for the poor; for the rest, it is limited to no more than about eight per cent of income. The vast majority of families, who had insurance through work, didn’t notice a thing when the program was launched. But those who had no coverage had to enroll in a plan or incur a tax penalty.

The results have been remarkable. After a year, 97.4 per cent of Massachusetts residents had coverage, and the remaining gap continues to close. Despite the requirement that individuals buy insurance and that employers either provide coverage or pay a tax, the program has remained extremely popular. Repeated surveys have found that at least two-thirds of the state’s residents support the reform.

I'm hoping the 8% of income figure is doable on a national scale. I would think it should be, as the figure I've seen regarding the current, private administration bureaucracy is that it comprises approximately 20% of average costs. Eliminate that bureaucracy, with its wasteful redundancy, and medical costs should drop dramatically.

Then there may be unnecessary redundancy of medical services by hospitals as well. Does every 27-room hospital need high-priced diagnostic equipment, and the payrolls to support them? Or can those services be more efficiently offered by having more centralized centers, so that the equipment is used more efficiently?

Lots of possibilities to reduce costs. My current favorite is to make the system provided to federal employees an option available to those who are willing to pay to enter.

What I strongly disagree with, is any system which puts the financial burden on employers. The net effect of that kind of system is/will be that employers will hire less workers, or classify workers as "sub-contractors". In today's world, I can't see how we'd return to a system where employers are the guarantors of employee health. It's inefficient, and may lead to a large legal bureaucracy for enforcement that would negate any possible economic viability.