Instead of calling this "universal healthcare", can we call it a bailout for the insurance industry? Why exactly is it that they would oppose it?

My biggest concern is that some insurance companies, being publicly traded, have a primary interest in maximizing profit and not in paying for health care. Without adequate oversight the healthcare mandate could become another trickle down program with the insurance companies sucking up public funds to fatten their coffers.

I think we need to see any plan before we jump on it. For over a year ago all of the major Democratic proposals have called for changing not destroying the existing health insurance industry. If the final plan eliminates cherry picking and extremely high premiums for older Americans or Americans with existing conditions and produces an affordable policy for every American I think we need to make sure it passes. I would like to see one program covering cradle to grave.

That said, it is clear that a plan that continues the insurance industry middlemen will be more expensive than a single payer government operated plan. That can be readdressed in a few years as the economy recovers and people start trying to figure out how we are going to pay for all the bailouts. In the meantime we shouldn't make the perfect the enemy of the good.

Unless insurer's administrative costs are limited this will be a boon for their continued profits and bonuses.

For more savings I suggest the following which cost nothing.

1. Require the government and pharmaceutical companies to negotiate prices for patented medications purchased for government programs and beneficiaries. Including Medicaid, Medicare, the Federal Employee program and Tricare this would affect 100 million citizens (1/3 the population of the U.S.) Since we like transparency we should make the negotiated prices public.

2. Enforce the reasonably pricing provisions of Dole-Bayh. Retrieve the taxpayer’s contribution to drug development costs (approximately 20 billion a year to basic medical research) from patent holders and use these proceeds to defray pharmaceutical prices to consumers. This would also require the disclosure of the real development costs of pharmaceuticals.

3. Prohibit direct to consumer (DTC) advertising. In a 30 second ad full disclosure as outlined below is not possible. As a result patients do not fully understand the limits and costs of any given product. Few countries allow such advertising.

4. If we don’t wish to completely prohibit DTC advertising, require full disclosure. This would include mention of the risks of treatment and a summary of proven benefits and competing approaches in clear language that a lay person can understand. The price of the medication, with estimates of monthly and yearly costs as well as a measure of cost effectiveness (cost/unit of additional survival time or other approved measure) must be also be provided to fully inform the consumer.

5. Require clinical studies to include cost data as well as a measure of cost effectiveness (QALY-Quality adjusted life year or other) in the discussion of any phase II, III or IV study reporting positive results.

6. Monitor the FDA approval process to be certain that generics come to market quickly on patent expiration.

7. The Canadian system controls patented drug prices by not allowing marketing unless the drug is priced right. A similar program could be instituted here to decrease our pricing to the level of other industrialized countries.

8. Alternatively, link the length of patents to reasonable pricing. As part of the FDA approval process the proposed price of the new medication would be compared with similar medications already on the market and with the same medication in other countries. The same process that the Canadian patent drug review board uses. If priced a significant amount over the comparator, the patent length would be decreased by some period of time to be determined by the review process–there are many ways such a link could be structured. For unique innovative drugs the cost of development could also be factored into the pricing length of patent equation. Price increases during the duration of the patent would be tied to the rate of inflation. If they exceed that rate the patent length would be proportionally shortened.

www.medicynic.com

I would advise severe caution in thinking these health care companies are sincere. Remember the Medicare Act that provided prescriptions to seniors? Both the health care and pharmaceutical industries were opposed to it in the beginning but switched their tune when they decided to "mole in" and basically wound up writing the legislation. I was inside the pharma business at the time, and it was a real bait and switch operation.

I hate to agree with those who see this as a disturbing development. What the insurance companies agree with almost, by definition, is bad for the rest of us.

I am absolutely a supporter of universal health care. I think, basically, access to health services is a very basic social right and any society that isn't making it universally available is failing miserably in its duties to its members.

That said, what *terrifies me* is that we enshrine at the policy level something like the current legal obligation to purchase auto insurance, which basically puts everyone who wants or needs to drive a car at the *mercy* of a bunch of for-profit businesses.

If any conscious person thinks that the health insurance companies aren't salivating at the prospect of a similarly mandated pool of new customers who will buy any crap coverage they can think up and overprice, and then go out of their way to never pay up on by keeping obstructionist lawyers on retainer and exhausting claimants (auto-insurance strategy for eons now), that person is insane.

If this is done as a mandate, then either the government needs to offer a reasonable adult basic insurance policy that can be paid through a payroll tax and supplemented by private insurance (aka, the current medicare model) or they need to ensure that there are some serious automatic minimums in coverage, limits on legal challenges by insurance companies to claim payouts, and heavy price controls at the lower end of the coverage spectrum.

Otherwise, all this is going to do is allow the insurance industry to get its filthy hands around the necks of all the people who currently feel that they can't afford coverage and squeeze.

Perhaps that infamous TV couple from '93 has hit the "Donut Hole".

Those sellouts to the Pharmas and Insurance industries in the Medicare revisions were due to the inclusion of Sen. Max Baucus as the roll over putz. Can't believe he has grown a spine, since then. So, be very careful of another sellout to the Insurance lobby. Ron Byers makes excellent points about the need to change the system.

Sigh,

Something smells about the 'insurance companies suddenly being for universal coverage' part of this. I am absolutely a supporter of universal health care. I think, basically, access to health services is a very basic social right and any society that isn't making it universally available is failing miserably in its duties to its members.

That said, what *terrifies me* is the possibility that we are abotu to enshrine at the policy level something like the current legal obligation to purchase auto insurance, which basically puts everyone who wants or needs to drive a car at the *mercy* of a bunch of for-profit businesses.

If any conscious person thinks that the health insurance companies aren't salivating at the prospect of a similarly mandated pool of new customers who will buy any crap coverage they can think up and overprice, and then go out of their way to never pay up on by keeping obstructionist lawyers on retainer and exhausting claimants (auto-insurance strategy for eons now), that person is insane.

If this is done as a mandate, then either the government needs to offer a reasonable adult basic insurance policy that can be paid through a payroll tax and supplemented by private insurance (aka, the current medicare model) or they need to ensure that there are some serious automatic minimums in coverage, limits on legal challenges by insurance companies to claim payouts, and heavy price controls at the lower end of the coverage spectrum.

Otherwise, all this is going to do is allow the insurance industry to get its filthy hands around the necks of all the people who currently feel that they can't afford coverage and squeeze.

Apologies for the double posting.

Like pretty much everyone else so far, I am FOR universal, single payer health care - I am AGAINST mandated health insurance.

Most of the country is like me - if they weren't, we'd be talking about President-elect Hillary Clinton.

Hospitals may want to get paid.

But, IME, doctors want their administrative costs lowered. In general, if we keep the for profit gate-keepers in place as part of this reform, it will fail to reduce costs and to provide a focus on preventative care.

Add me to the list of people who are leery of this. And pardon me while I shout:

"UNIVERSAL HEALTH INSURANCE DOES ***NOT*** EQUAL UNIVERSAL ACCESS TO AFFORDABLE HEALTH CARE!!!!!!"

The Wall Street Journal has a good piece today,...

Motivations vary depending on the interest group. Business groups want to reduce the cost and improve the quality of care.

Well, they're half right.

You can't have mandated coverage without mandated participation, and that's one reason the insurance companies demand it. The other reason, of course, is that they would be overjoyed to increase their customer base by 47 million people, as long as risks are spread evenly, and are actuarially determinable, as they would be with mandated participation.

Continuing to have private insurers in the delivery chain of medical care at all makes about as much sense to me as feeding oats to the sparrows through the digestive tract of a horse. I have no problem with instituting single-payer national health care and cutting out the middlemen.

We see universal care; they see Medicare Part D, only even more profitable.

Universal coverage without community rating is just an enormous invitation for price gouging at taxpayer expense. The profit model of insurance companies is still based on denying care; with a universal coverage requirement they'll just have to do it differently. Maybe by retroactively sticking you in a high-risk policy when you get sick...

The one good thing about this is that it would eliminate the pool of young, healthy people who go uninsured because it's too expensive (and because if they have anything catastrophic they don't have enough assets to bother seizing anyway).

If the insurance industry lobbying group is satisfied with the plan that emerges, it will only be because it's a stinker. No good plan would even keep a role for these buzzards.

The greed in the insurance industry makes the greed on Wall Street seem tame by comparison. If they are agreeing to expand coverage it is not because that is what they want to do that, but because they believe it will put them in a better position to negotiate (at the very least, by generating good will), and hopefully not have to do the very thing they say they are going to do. This announcement is political maneuvering, not an agenda. Forgive my cynicism.

Can someone provide figures as to this mythical pool of young, healthy people who go uninsured by choice. As far as I can see, no-one goes without health insurance if they can help it. Note that this is different to "I can't afford health insurance" which is not age or health specific.

Almost all those young healthy people stay healthy by playing sport or working out. And strenuous activity like that pretty much requires coverage, in case of injury.

The idea that "I'm healthy, I don't need health coverage" is a right wing talking point to suggest that health coverage is a commodity, not a necessity.

Universal Health Care (a la most affluent nations) will NOT be achieved by feeding the greedy insurance companies.

Imagine these insurance companies running our public schools, the fire department, the police department, the highway department, ... Why do we allow them to deny us real health care?

We need to see two things out of a mandate plan.

1) A medicare like government insurance option available to everyone.

2) Some mechanisms to limit cherry picking by private insurers.

I am confident that given even a partially effective 2 1 will out compete private insurers over time and marginalize them. Once that happens we can move to universal single payer insurance much more easily.

The insurers, I suspect, either think they can out compete a government plan by cherry picking (they can't do it in medicare advantage, so I doubt they can do it at all), or don't care that in the long run their industry will be destroyed because the executives making the decisions get paid in the short run.

Following up on Hilzoy's overnight item, momentum for major healthcare reform in the next Congress got a little stronger yesterday, when the health insurance industry said it would support extending coverage to everyone, in exchange for a healthcare mandate for all Americans. Given the insurance industry's role in helping kill the Clinton plan 15 years ago, this is obviously an important development.

I'm trying to see how it surprising that an industry supports the government subsidizing purchase of its product in "exchange" for a mandate for everyone to buy that product.

I mean, is there an industry that wouldn't support either half of that with regard to its products whether or not the other half was included? Where is the "exchange" here?

Seems to me that, from the insurance industry's perspective, they are saying they will "accept" a government handout in "exchange" for an even bigger government handout.

One enormous and critical piece is missing and most likely will be.

I think that the failure to include professional nursing will be its demise as a legitimate profession and will be a permanent open wound in that preventable patient harm and deaths will occur and the profession charged with assuring patient advocacy will be transformed and made smaller as a dependent, assistant technician unable and unwilling to advocate for patients in any meaningful way. (link at my name to my eulogy)

Any significant change tot he existing system for health car coverage will be a huge battle, with tons of money opoured into influencing public opinion. After it's changed, and the changes preserve the insurance industry's interloping control over the receipt of health care, there won't be any desire on the part of Congress to mess with the system again. This won't be a step to a single payer system. We need to make a full court press for a single payer system first time out. The conditions won't be so close to ripe again soon.

ghillie, as Ed K (twice) and JeffF have said, as long as the "mandated" coverage includes an option to purchase government-sponsored, not for profit insurance plan, it *will* function as a step toward single-payer.

This is why I liked Hillary's plan better than Obama's. Hillary's plan had, among the choices, a plan offered by and run by the government, just like Medicare. IMHO, that was the "back door" to single payer. If the gov plan was cheaper (due to lack of profit-taking) and more comprehensive (due to lack of a profit-incentive to deny care), eventually, everybody would pick that. Employers could choose (and pay for) that plan for their employees, too.

Obama's didn't have a comparable element - he would allow people to buy into the government "pool" - which is a collection of plans offered by private insurers, and government employees can chose from among those plans whichever one suits their circumstances best. But, again those offerings are provided by private insurers.

Like many others have pointed out, Americans don't need medical insurance. They need medical care. Michael Moore entertainingly pointed out the difference in "Sicko".

I can't comprehend why so many Americans have been so terrified of some "guvmint byooo-ro-crat" - accountable to the electorate, hired on the basis of merit - reviewing their case, while being just fine with some private corporation's bureaucrat, hired and paid and bonused to deny care whenever possible and accountable only to the corporation's bean counters, deciding the same thing.

You think there are long waits under "socialized medicine"? Just try to get an appointment with a dermatologist or ob/gyn. Just try to schedule a colonoscopy.

This is very encouraging news. The bottom line on health care reform is that it requires two essential elements to work: (1) insurance companies must stop the practice of denying health coverage to people with pre-existing conditions, and (2) everyone must be required to carry coverage. While the mandate provides some benefit to insurance companies, the real beneficiaries are the insureds because the pool will be large enough, and have a sufficient balance of healthy and unhealthy people, to keep costs down. Without a mandate many people, particularly young people, will forgo coverage until they get sick or have an accident. That ecenario shifts the balance in the pool heavily toward those with higher costs and drives up the cost of insurance. I'm no fan of health insurance companies and their hideous practices, but the only workable solution involves these two elements. As Obama has said, if we were starting from scratch, we might opt for a single payer government system, but for economic reasons, among others, we need to keep insurance companies in the mix. And, frankly, that option looks better to me now, after dodging a McCain-Palin bullet on Election Day. As bad as the private insurers are, I would not want someone like Palin having a hand in deciding what medical treatments the government should cover.

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Like everyone else here, I'm for eliminating the multitude of middlemen (insurance) in health *care*, which is why this sudden volte face worries me instead of making me hopeful.

I'm in a small town, where the majority of those who are covered, are covered by a fairly small number of plans, so that all the doctors in the area accept them all. But, if someone comes from a different state and gets sick while visiting, it's tough luck and emergency room only. As it is, both doctors I have visited in the past year have to employ extra two people (each) who do nothing else but harry the d...d insurers into paying what they ought.

And I've heard from a friend in NYC, that half of the doctors she has to visit (she has a congenital bone and nerve problem, which requires lots of specialists) won't take *any* plans at all; it's all cash on the barrelhead for every visit...

I grew up in "commie" Poland, with all the attendant problems (long waits, hospital overcrowding etc) and I still think I had better care there than I do here.

Of course, there are many points of disagreement on healthcare reform and numerous difficult decisions and compromises to be hammered out. But there’s also widespread agreement on at least two critical reform requirements.

-- Electronic health records (EHR). Bringing together the major medical systems has been a priority of current HHS Secretary Michael Leavitt, and will likely be backed by his probable successor Tom Daschle. EHR adoption is still low, so the opportunity is real and big.
-- Evidence-based medicine. Stakeholders agree that all efforts and systems should be based on sound medical science and published literature. The new systems need to assure and deliver quality, consistent care, incorporating the best diagnostic and quality care guidelines. These guidelines need to be available at the patient’s bedside as well as throughout payer and provider organizations.

These two concepts give us a starting point for the emerging health reform compromise. I'm looking forward to seeing more points of agreement emerge as the reform conversation gains volume.

Possibilities? www.healthcaretownhall.com

A lot of commenters are skeptical here, as well they should be. Check out Ezra Klien's blog from earlier today:

http://www.prospect.org/csnc/blogs/ezraklein_archive?month=11&year=2008&base_name=a_conversation_with_americas_h#comments

Bottom line? They say nothing about making that mandated insurance affordable; thus they get the best of both worlds.