I’ll admit upfront that I’m well behind in all my policy reading, but as a citizen and someone who works in healthcare, I have to wonder why this makes sense.
- Is it to lower administrative costs as Kathleen Sebelius said on TV this morning? Since they only represent ~10% of the total healthcare costs, that’s not going to make a big difference.
- Is it to provide coverage for the uninsured? This seems like a fundamentally good cause but how is that population defined. Why can’t that happen in the existing system with the right incentives / mandates?
- Is it to provide competition for the current insurers? This seems like a bad path. Government competing with industry…will the playing field be even?
- Is it to provide a government subsidy to those that can’t be profitably insured? Again…this is probably in the social interest of the country. Can it be done w/o simply overspending?
- Is it to drive a long term investment in preventative care? Now, this seems like an interesting perspective. We know one of the issues with long-term investments in patient care is that members churn. If I invest today in a member that I won’t have, I don’t get my money back.
I think my point here is that a public system (IMHO – In My Humble Opinion) isn’t the right question. We have systemic challenges around incentives, payment structure, long-term care, supply and demand, health literacy, etc. that have to be addressed.
From what I’ve seen in Medicare Part D (PDP), I have no faith that a public system would manage trend. They won’t even push people to chemically equivalent generics. They blindly pursue re-importation. They don’t have a very limited formulary. They don’t have aggressive utilization management programs (e.g., step therapy).
Someone needs to set an aggressive goal of keeping trend to 0% for the next decade and then work toward that.
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