F/u on Linda and Ellen's comments. (based on Nancy's posting of MoveOn's positive critique).
Here's more context: It all boils down to the Federal Employees model or the Medicare model, the latter being the gold std.
Last week Obama proposed $634 billion over 10 yrs for HC spending with no specific details, but goal of covering the uninsured. Details left to congress to debate as next step in budget process. Bottom line: good start on financing mechanism (half from taxing the wealthy, and $177 billion more from repealing overpayments to HMOs which contract w/ Medicare, which caused HMO stocks to tumble). To f/u on Linda's post, i too see nothing so far about fed. govt replacing HMOs in negotiating drug prices for seniors.
But, "devil in details". Obama's HC economics advisers are not you and me. They are: David Cutler, David Blumenthal, and Jeffrey Liebman all of Harvard; Stuart altman of Brandeis; Austin Goolsby of U of Chicago. (Dashle never got confirmed, didnt pay taxes, AND major conflicts of interests, ties to insurance industry). Their advice resulted in Obama CAMPAIGN'S Universal HC plan (which Ellen posted,see below), essentially,the "new public plan" is the Federal Employees Health Benefits Plan FEHBP model, retains COSTLY HMO insurers. FEHBP would be available both to employers who choose to pay in, or uninsured individuals (eliminating pre-existing conditions on the front end,only to not pay on the back end).
Obama DID campaign on the Medicare model as an additional option to FEHBP (ONLY after pressure from edwards campaign), but this appears to have been scuttled. Problem is, FEHBP is a managed competition model, pools 9 million Federal employees who receive voucher (premium support payment) used to pick among HMOs,PPOs etc by comparing cost and quality. Managed competition has been discredited, essentially because huge insurers can't compete with themselves.
So estimated cost of Obama's Universal Health Care proposal which he campaigned on (Federal Employees model), was $1.17 trillion over 10 yrs by Lewin Group ( their 'econometric" model is generally reasonable, yet difficult to verify, proprietary); Urban institute/Brookings Institute est. was $1.6 trillion over 10 yrs. Hence, discrepancy between these estimates which assumed UNIVERSAL coverage and the $643 billion over 10 yrs, which wont come close to UHC.
In contrast, Physicians' for National Health Program's (and most of the rest of the world's) UHC estimate uses a single-payer, Medicare for All model: a std of efficiency (stdized benefit, uniform payment, automatic coverage, no oop costs) which costs $350 billion by eliminating insurance company admin waste, covers all, pays for itself, all in the first year of implementation. (47 million uninsured persons in the U.S. x $7,000 per capita cost of HC, you get about $330 billion to insure the uninsured; covers it).
So those are the two basic models: Federal Employees (HMO insurers) and Medicare (government-funded, a public good). Anything moving in the direction of the Medicare model will be good first steps: govt negotiating Rx drug prices for seniors, getting HMOs out of Medicare, Medicare setting global operating budgets to replace current (DRG) billing for hospitals. finally, Obama's $750 stimulus pkg does little to make STRUCTURAL changes in HC, and in the future if we are going to solve both the HC and economic, structural changes in Hc is what it will take.
joel
Joel Albers Pharm.D., Ph.D.
Clinical Pharmacist, Health Economics Researcher
Universal Health Care Action Network - MN
Community/University Collaborative Research
www.uhcan-mn.org
phone: 612-384-0973
address: 3500 35th ave S
Mpls, MN, 55406
On Mar 1, 2009, at 7:57 PM, Ellen Shaffer wrote:
Obama's campaign plan, which I was still able to find online, said this:
" (1) OBAMA'S PLAN TO COVER THE UNINSURED. Obama will make available a new
national health plan which will give individuals the choice to buy
affordable health
coverage that is similar to the plan available to federal employees. The
new public plan
will be open to individuals without access to group coverage through
their workplace or
current public programs. It will also be available to people who are
self-employed and
small businesses that want to offer insurance to their employees.
"(2) NATIONAL HEALTH INSURANCE EXCHANGE. To provide Americans with
additional
options, the Obama plan will make available a National Health Insurance
Exchange to
help individuals who wish to purchase a private insurance plan. The
Exchange will act as
a watchdog and help reform the private insurance market by creating
rules and standards
for participating insurance plans to ensure fairness and to make
individual coverage more
affordable and accessible. Through the Exchange, any American will have the
opportunity to enroll in the new public plan or purchase an approved
private plan, and
income-based sliding scale subsidies will be provided for people and
families who need
it. Insurers would have to issue every applicant a policy, and charge
fair and stable
premiums that will not depend upon health status. The Exchange will
require that all the
plans offered are at least as generous as the new public plan and meet
the same standards
for quality and efficiency. Insurers would be required to justify an
above-average
premium increase to the Exchange. The Exchange would evaluate plans and
make the
differences among the plans, including cost of services, transparent."
http://www.barackobama.com/pdf/HealthPlanFull.pdf
It suggests that he would support a public health insurance plan.
However, he has not written and probably will not write legislation, as
you note, though HHS and the White House health reform office will
likely be in regular contact with Congress. There have been informal
reports from the Finance Committee that the public plan is not viable;
this is not the final word, but at least reflects the strong opposition
they are hearing.
I haven't heard of Obama expressing support for any health reform
legislation recently All the members and committees you mention are
reportedly working on legislation. Commonwealth recently published a
Lewin analysis of a range of health reform bills from the last session
of Congress; it lumped in HR 676 with HR 193, which it characterized as
Medicare for all bills (not quite accurate). It showed Stark's HR 193
as the only plan to cover everyone, and would also save money. Could
influence the debate, and the discussions in Congress.
- Ellen
Lindazf@aol.com wrote:
> Ellen,
>
> Am I understanding you correctly that a public plan option is now out
> of Obama's plan?--not that he is proposing one any more but
> leaving details to Congress, as I understand it. Out of which plan,
> HELP and Kennedy's, Waxman's? Who actually is developing
> legislation? Those are the ones that Obama will support--not Conyers'
> or Stark's.
>
> And has Obama actually changed from his campaign position/promise that
> his health care reform would have a public plan as an option? Or am I
> mistaken that he promised that?
>
> Also does anybody know if White House is putting out a list of who is
> invited to the health summit meeting? I looked all around their
> website and could not find a list of who was invited to the fiscal
> responsibility summit. It seems to me that these names should be
> public--or it looks too much like how Clinton health reform was developed.
>
> Linda
>
> ----------------------------------------------------------
> Get a jump start on your taxes. Find a tax professional in your
> neighborhood today
> <http://yellowpages.aol.com/search?query=Tax+Return+Preparation+%26+Filing&ncid=emlcntusyelp00000004>.
--
Ellen R. Shaffer, PhD MPH
Co-Director, Center for Policy Analysis
San Francisco Presidio
P.O. Box 29586
San Francisco, CA 94129-0586
phone: 415-922-6204
fax: 415-885-4091
cell: 415-680-4603
www.centerforpolicyanalysis.org/www.cpath.org
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