4 Points on Health Care


By Joe Campbell
August 12th, 2009

There’s just too much going on in health care – too many important points to make and second. So, here’s another hodge-podge post on health care.

Zeke Emanuel. Alex Koppelman addresses the irony of the fact that Ezekiel Emanuel – Rahm Emanuel’s brother and a member of the Office of Management and Budget – is one of the centers around which the conspiracy theories about death panels and such are flying. As a leading bioethicist, he has written academically about many hypothetical scenarios – and now, they are being taken out of context to suggest he is in favor of all sorts of Nazi-like practices. In fact, Emanuel is not even in favor of physician-assisted euthanasia:

[Zeke Emanuel] is actually one of the country’s leading medical ethicists, a forceful defender of people approaching the end of their life. Indeed, he opposes even voluntary euthanasia and physician-assisted suicide.

The Eight Point Plan. Matt Yglesias had an important post today – pointing out that though most of the attention on health care reform is being given to the public option (and to a lesser degree the Health Insurance Exchange), neither of these will affect the health insurance received by most Americans. (Though if done right, the public option and exchange would provide a measure of security to Americans as they realize they could lose their job as well as health insurance.) Instead, Yglesias says :

For those of us outside the exchange, the core of health reform is this eight point plan to make health insurance better by blocking dirty tricks by private insurers.

The Purpose of the Public Option. Jacob S. Hacker defends the public option in a white paper [pdf]  written describing the purpose of the public option in the Health Insurance Exchange:

The public Medicare plan’s administrative overhead costs (in the range of 3 percent) are well below the overhead costs of large companies that are self-insured (5 to 10 percent of premiums), companies in the small group market (25 to 27 percent of premiums), and individual insurance (40 percent of premiums).

What if the right “wins”? David Frum asks what it would mean for conservatives and right-wingers to “win” the health care fight. This Republican’s answer:

We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion.

Risk Adjustment in a Health Insurance Exchange. DiA asks a few questions of health care blogger Ezra Klein. Klein makes a point I hadn’t realized – that the legislation as currently written does not include a “risk adjustment fund” without which insurers could simply race to the bottom in creating plans. Without this, the Health Insurance Exchange would seem to offer nothing like an “ebay for health insurance.”

DIA: The House health-care bill includes universal community rating. But it doesn’t have a risk equalisation fund to compensate insurance companies who get stuck with the riskiest and least healthy clients. Doesn’t this ensure a race to the bottom in terms of the benefits companies offer, in order to discourage the unhealthy from signing up with them? Won’t they all just offer the minimum possible benefit package they can under law? (The point of the REF system, used in Germany and the Netherlands, is that companies actually offer extensive benefits and compete with each other to cover the older and less healthy, because they draw in more government compensation that way.)

Mr Klein: A risk adjustment fund is crucial, and, happily, a lot of senators understand that. I’d expect some form of risk adjustment to be added into the bill by the end. But you’re right: Without risk adjustment, the exchanges can’t really work, which means they can’t really grow, which means we won’t have changed much of anything at all.