Choice, Competition, And Flexibility, Part II: Market-Driven Alternatives To Single Payer

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      eridani
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      Part I
      https://www.healthaffairs.org/do/10.1377/hblog20200813.191190/full/

      Part II
      https://www.healthaffairs.org/do/10.1377/hblog20200814.33844/full/

      Recent progressive health policy efforts remain firmly anchored in a political philosophy that champions national regulation and central control, sitting in direct conflict with consumers who strive for mass-customized health care. Currently, consumers and clinicians are persistently frustrated, as both strive for choice, flexibility, and modernity in an otherwise dysfunctional system. In selecting health benefits, consumers face an impossible task: to predict their trajectory as patients, a challenge when the healthy office worker one day can become a terminal cancer patient the next. In this setting, a single benefits package is at its core unfair—a person’s needs change over time, and they should be able to change and customize their coverage as they progress through different stages of life.

      Comment by Don McCanne of PNHP:  Universal publicly-administered and publicly-financed health care programs work well for everyone. In contrast, the most expensive health care system of all – ours – uses a fragmented system of administering and financing that includes choice and competition of private insurers, and that has been a disaster, leaving tens of millions with inadequate coverage or no coverage at all.

      It is difficult to understand the obsession with injecting consumer-driven choice and competition into the mix when the private plans and the burden they place on the health care delivery system have defeated the goals of universality, equity, efficiency, affordability, accessibility, and social solidarity. Yet here we have another article advocating for this market-driven approach.

      Although this two-part article repeats many of the usual conservative talking points, the excerpt above reveals a fundamental flaw in their premises that alone shoots down their model of reform. They seem to understand that it is not the choices in health care itself that makes the market work but rather it is the choices in private insurance products that they seem to believe makes the health care market effective. They claim that a single benefits package that applies to everyone is unfair because “a person’s needs change over time, and they should be able to change and customize their coverage” to fit their needs. So they provide the example of “the healthy office worker one day can become a terminal cancer patient the next,” though they concede that consumers face an impossible task in predicting their trajectory as patients. Even if you knew you had a specific cancer, you could not purchase coverage for that cancer alone because the insurers must pool risk, and if such a product even existed, it would have to be sold to people without that cancer. Otherwise that insurance product would have to include the full costs of the care for that malignancy plus the administrative costs and profits of the insurer. Retail plus maybe twenty percent is not a bargain that would find a niche in the marketplace. Selecting in the market only the insurance you need is impossible.

      We really don’t need these analyses anyway. Not only do we have the most expensive system of all nations, though we leave tens of millions out in the cold, private insurance is the most expensive component of health care financing when adjusted for the health of those covered. Of course, that’s how insurance markets work, selectively sell to the healthy while shoving the sick into government programs or simply into the street. That is why all that money we are already spending on health care plus insurance administrative costs is still leaving so many facing financial hardship or, even worse, leaving them with physical suffering or death due to lack of health care.

      Throw out the private insurers, recover the wasted funds, establish a single universal risk pool, and then take care of all of us through our own public, single payer model of Medicare for All. Simple.

       

      USPS Warns Employees Not to Speak to Press

      https://www.vice.com/en_us/article/k7qypz/usps-warns-employees-not-to-speak-to-press

      The memos also include a curious line that seems to conflate the different types of publications reporters work for and social media networks. “If you are contacted by a media representative for official comment, including, but not limited to: newspapers, radio, television, and social media such as Twitter and Facebook; follow the steps below,” the Appalachian District’s memo reads. The Greater Michigan District’s memo likewise says “Here are our district guidelines for how to handle media requests for official comment, including newspapers, radio, television, and social media such as Twitter and Facebook.” It’s not clear why Twitter and Facebook are mentioned here.

      It is all too common for organizations public and private to remind employees they are not authorized to speak to the media. Instead, they urge them to direct reporters through official channels to, as the USPS put it, “protect its brand.”

      But well-run organizations don’t try and stop employees from talking, an especially fruitless endeavor for the USPS which has a 630,000-strong heavily unionized workforce. Typically, well-run organizations try and fix the problems the employees are talking about instead.

      If you’re an employee with the USPS and know something the public ought to know, my email is aaron.gordon@vice.com and here are instructions on how to contact me securely. One of the best ways to do so is to send me a letter. In the mail.

       

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

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