Money Talks
The Health Affairs blog site has an interesting series of comments about the CA health reform initiative. Mandatory reading for anyone interested in health reform, a.k.a. the uninsured. California’s plan was pieced together with much discussion and compromises all around. Seemed like a classic case where everybody got something but nobody got everything. The leadership of Gov. Schwarzenegger is widely credited with getting the package on the table. His mantra of “shared responsibility” was manifest in several difficult aspects of the final plan. As Patricia Lynch said, “Organizations that rarely work together were willing to moderate their differences and stretch their comfort zones to achieve larger goals.”
One of the sticking points was individual mandates. Should everyone be forced to purchase health insurance, even if they don’t want to? The instinctive answer is ‘no.’ I don’t have life insurance, and no one would force me to buy this. On the other hand, if I want to drive a car, I have to have auto insurance. So what about health insurance? In a society where everyone who wants health insurance can purchase it, there is no need for a mandate. However, as soon as you decide to provide it for those who want it but can’t buy it, then a mandate is essential. The nuances of the arguments are presented in the HA blog, but the bottom line is that insurance companies need the premium income from those who buy it but don’t use it.
There was wide support for insuring the uninsured, and all players finally agreed on what the plan should look like from a benefits perspective. Then came the question of who should pay for it. Under “shared responsibility,” there was something for everyone to hate. The share for the State of California in combination with a failing economy eventually sank the ship. Too bad Arnold hasn’t been following this blog! He would have known he could pay for the program with improved efficiency in healthcare delivery processes.
The California initiative is an important lesson and model for the coming national debate. All the relevant issues are there on the table, and the HA blog provides a good discussion.
One of the sticking points was individual mandates. Should everyone be forced to purchase health insurance, even if they don’t want to? The instinctive answer is ‘no.’ I don’t have life insurance, and no one would force me to buy this. On the other hand, if I want to drive a car, I have to have auto insurance. So what about health insurance? In a society where everyone who wants health insurance can purchase it, there is no need for a mandate. However, as soon as you decide to provide it for those who want it but can’t buy it, then a mandate is essential. The nuances of the arguments are presented in the HA blog, but the bottom line is that insurance companies need the premium income from those who buy it but don’t use it.
There was wide support for insuring the uninsured, and all players finally agreed on what the plan should look like from a benefits perspective. Then came the question of who should pay for it. Under “shared responsibility,” there was something for everyone to hate. The share for the State of California in combination with a failing economy eventually sank the ship. Too bad Arnold hasn’t been following this blog! He would have known he could pay for the program with improved efficiency in healthcare delivery processes.
The California initiative is an important lesson and model for the coming national debate. All the relevant issues are there on the table, and the HA blog provides a good discussion.
