Health Care Reform

In one of my classes we were asked to write a hypothetical proposal for health care reform as if we were an adviser to one of the Presidential candidates. Here's my response:

Great question. I've done a bit of research on the current proposals for my work, so you'll probably get a longer answer than you wanted.

My answer depends on who the candidate is and at what stage of the game we're at. You need to be general enough to not tie yourself down in the Nov election and once elected, but specific enough to get yourself to that point. First of all, recent polls show that people on both sides of the spectrum see health care as one of the top issues of the campaign (one poll this week had health care tied with Iraq among democract voters), so both sides should definitely talk about it. That being said, I think that during the primaries Republicans need to be careful not to support anything too closely resembling "socialized medicine" or requiring a lot of gov't regulation, or even the most well-meaning candidate won't have a realistic shot of making it past Iowa (or whatever state ends up being first). With Rudy leading all the polls, conservatives are showing they're willing to have someone who has been pro-choice and in favor of gay rights, as long as they stick to the free market system and don't let gov't get too big. I would give a Democrat similar advise, suggesting they learn lessons from 93-94, and not get themselves too locked into one firm inflexible set of ideas now, since it would cost them later, either in the general election or during congressional battles. I find it interesting that this is exactly what Hillary has been doing. Other candidates aren't as well known and would probably need to be more specific and focused in their platform to give themselves a fighting chance. If I were advising one of them, I would suggest they focus on answering the following questions:

1) Will the plan be universal? Yes.

2) How? With "shared responsibility" by employers, employees, and everyone else. I am intrigued by Edwards' proposal of creating regional health markets (essentially the Clinton plan of the 90s though I would do everything possible to de-emphasize the similarities) and think that might be the way to go. There would need to be some minimum standards set up, but it shouldn't be too overly regulatory (or it would never get passed). This way, individual states would have freedom to pursue the path that best suits their needs. Perhaps include an individual mandate, as the Mass. plan does, so you can cut down on emergency room spending, but not require anyone to change plans if they don't want to. I would also sign an SCHIP bill like the Senate and House just passed and get rid of the ridiculous new HHS regulations on how SCHIP expansion would have to be applied. There's enough support on both sides of the aisle that I think this could get done. As all the Dems are saying, I'd get rid of restrictions based on pre-existing conditions.

3) How will it be paid for? As all the Dems are saying, the main way would be through letting the Bush tax cuts expire in 2011 (Obama's people estimate that would bring in $65 billion). Also, think of the available money once we're out of Iraq. I think we spend something like $8 billion per month in Iraq! The democrats could become the party of small gov't by putting some of that money (which never seemed to be availble for anything in the past) towards universal coverage. Also, the idea would be that with regional health markets, and not screening out pre-existing conditions, operating costs to insurance companies would be dramatically lower and due to local competition, they'd have incentive to pass the savings on to the consumers.

4) Why would this system be better? Like Rena, I would increase the focus on prevention and would try to eliminate a lot of the wasteful spending that goes to bureaucracy by improving health information technology. Improved use of technology would also increase access to health care for those living in rural areas. As I heard Rudy say this week (advocating a different plan), the average person our age will change jobs repeadetly during the first 20 years of our careers. By making our insurance status independent of our job status, we'll see increased stability and savings, as well as fewer people uninsured because they're in transition.

The tag line would be that the plan is universal, affordable because it's not overly regulatory, and better because it provides choices and saves the average family $x amount per year.