Best of Both Worlds

Several notable economists have released a white paper offering a compromise health reform plan the “Best of Both Worlds.” They identify 5 priorities of reform:

  • Ensuring universal access to basic health care
  • Making health care affordable for the poor and sick
  • Restraining the growth of public spending
  • Ensuring the efficient provision of health care and health insurance
  • Respecting the diversity of patient values

These points are more big picture and less detailed, but still reminiscent of the plan I proposed in my book “Balancing the Budget is a Progressive Priority” published as ab ebook in August 2011, and then in paperback in 2012 that had as its centerpiece a suggestion for a bipartisan health reform strategy that I claim to be a necessary, but not a sufficient condition to have a sustainable federal budget over the long term. Here are my main bulleted points.

  • Replace the individual mandate with federally-guaranteed, universal catastrophic insurance coverage and sell private “gap” insurance in state-based exchanges
  • End/modify the tax preference of employer paid health insurance
  • End the Medicaid program by transitioning responsibility for dual eligible Medicaid costs to Medicare, while moving non-elderly low income persons into subsidized private gap insurance
  • Enable Medicare to become an active health care purchaser
  • Enact comprehensive medical malpractice reform
  • Adopt an overall cap on federal health care spending backed up with a tax-based fail-safe

The hardest part of the simple idea of providing a universal catastrophic health insurance system (or provision of basic care to everyone) is where the catastrophic insurance vehicle will come from. By far the simplest route is via Medicare. Still, in policy terms, the details are tractable.

However, our problem is not one of policy and dueling white papers, but one of politics. To have a deal such as the one I propose or the one noted above will require not only conservative scholars/think tankers to endorse a set of policies and interact with liberals and progressives–we could cut the deal over a long weekend–elected Republicans will have to identify what they are for in health reform. And be willing to lose an election over taking a tough vote to bring about something like the plan above (there will be plenty opposed to this, or any change). Elected Republicans have heretofore “free-riden” on whipping up rage about what they are against, and have never gotten around to what they would be willing to advance legislatively to shape the future of the health care system.

I am not sure how to change that, but it is what makes a deal 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

One Response to Best of Both Worlds

  1. Brad F says:

    Reminiscent of your plan? How about benevolently lifted 🙂

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