Could we even recognize a deal?

Robert Pear’s article last week claiming a general agreement for premium support across the political aisle caused ruffles.

  • Avik Roy was a bit incredulous.
  • Austin, who has written as much about premium support and competitive bidding as anyone, provided a reality check that the policy details are more important than the label.
  • James Pethokoukis said the Democrats owed Rep. Paul Ryan an apology for savaging his Medicare reform proposal if they were coming around on premium support in Medicare, while Kevin Drum said no way it was his details that were bad, and progressive policy wonks invented the idea in any event thank you very much.
  • Andrew Sullivan weighed in, making the critical distinction between deciding there will be premium support of some sort and not an unlimited amount, and determining how much that support will be (Austin’s FAQ makes this point over and over).
  • Yuval Levin is all for premium support in Medicare, but not in the under-65 age group, and he thinks the Democrats have been very hypocritical in their opposition to Ryan’s reforms given that they have set up premium support in the ACA.
  • I have written about the many similarities to the ACA of the main Republican reform bill in the last Congress, the Patients’ Choice Act (sponsored by Ryan and Nunes in the House, and Coburn and Burr in the Senate), but this of course didn’t temper criticism of the ACA.
  • The Bipartisan Policy Center has done lots to promote the idea of premium support and competitive bidding through their Domenici-Rivlin Protect Medicare Act and that has provided some momentum.

There does seem to be some consensus that we want to set up better functioning markets for health insurance, and that we need to do so in a manner that could hopefully address health care cost inflation by harnessing competition. Both “sides” seem to mostly be focused on pointing fingers at the other for being hypocritical in selectively being for these principles (one group is for premium support and competition in the under 65 age group, but not in Medicare; and it is the exact opposite for the other group).

I think if a space traveler dropped in and saw all this for the first time, that they would assume we must be near a deal to move ahead with health reform. In policy terms I can see it, yet in political terms it seems impossible.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

2 Responses to Could we even recognize a deal?

  1. Will says:

    Great summary. Thanks.

  2. Mark Spohr says:

    There are a few fundamental problems to address before we can have “better functioning markets for health insurance”.
    – Standard coverage packages. It is currently impossible to evaluate different insurance packages since they vary so much in coverage and exclusions, deductibles, etc.
    – Cherry picking. There should be no process of “qualification” to buy a package. This is how insurance companies weed out high cost patients and distort the market.
    – Price control. No individual insurance company has as much power to control prices as the government so the market will not be able to control prices as well as the government could by mandating prices. I know this is controversial but it is common in most other developed markets (for example, Switzerland which is most like the US system).

    In the absence of these controls, it will not be possible to have a “better market for health insurance”. We can harness competition, but we need to level the playing field.

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