Saturday, August 15, 2009

Market Based Health Care Reform

A couple weeks ago, out for a glass of wine, the subject drifted to health care reform. The girl I was talking to said something to the effect that "We're not giving time to let the market work" on health care. Clearly the cost and quality of health care have been largely in the public eye the last 5 years in my opinion. I saw a lot of validity in that point. Also many recent studies I've seen stipulate that we spend much more, for lower quality of care then many nations out there INCLUDING some countries with nationalized medicine (which I am NOT explicitly in favor of at this time).

Then while reading the most recent edition of The Economist, I read a pretty fair article summing up the current debate and posturing on both sides of argument that had a great finish which indicated something similar:
Though it has a shameful history, the insurance industry has done a U-turn of late. It now accepts the need for a radical overhaul of insurance markets through measures such as guaranteed issue of coverage and the creation of health insurance “exchanges”. But its leaders are increasingly unhappy about the shrill attacks. Can Mr Obama continue to bash the insurers one day and rely on them the next?

Which got me thinking, perhaps the THREAT of legislation is enough impetus to resolve the issue. How can Barrack Obama have his cake and eat it too? I think he's a smart guy who hasn't shown himself to about face when confronted with reality. Rather than pushing health care reform now, I think he should declare a 6 month moritorium to allow the debate to continue so issues can get worked out. I also believe that he should insist that at this time the health insurance company should come to an agreement amongst themselves (a. la. market based regulators of the financial world. They (like NYSE for example) self regulate reasonably and pre-empt government action sometimes by implementing reforms first.

I think if the insurance companies did a good enough job coming up with a basic system of rights then the current motivation for reform would wane, and people could all have health care. I do think that at least providing preventitive care (which reduces emergency care later in uninsured) and emergency care for all makes sense, and probably that basic provision should come from the government. The reality is we're never going to see emergency care not provided as needed, because that's just wrong, and luckily everyone pretty much agrees.

On top of that poll numbers say that people don't agree with Obama's current approach, and I'm SURE that health insurers don't want too much more government control. I think that Obama/The Government should propose, and possibly pass, just a patient bill of rights. Here's my suggestions:

1) No disqualifying for insurance based on history. Costs are purely decided by age.
2) Government provides every citizen a voucher entiling them to basic preventitive care (i.e. physicals and immunizations), basic medical coverage, and reasonable emergency coverage.
Note: People with more money will always be able to pay for fancier things. Also we will NEVER have doctors refusing emergency care so SOME preventative measures (those which save money long term) should be free.
3) Alternative therapies' effectiveness will be thouroughly tested head to head so that that best cost solution is used.
4) All drug studies will be 100% transparent.

More to come......

Saturday, August 8, 2009

"Signing Statements" a.k.a. Line Item Veto

I didn't know that presidenta could sign a bill, then declare a provision of that bill unconstituional in his interprative instructions to his executive branch. This practice known as issuing "Signing Statements" apparently has been around for some time.

The New York Times covers this issue with a poorly worded and misleading "Obama's Embrace of a Bush Tactic Riles Congress," which at least they redeem with a fuller recount saying:

Since the 19th century, presidents have occasionally signed bills while calling a provision unconstitutional. But the practice was rare until President Ronald Reagan. He and his successors, including Bill Clinton, began issuing signing statements much more frequently and challenging far more provisions.

So it's not really a bush tactic, nor even a partisan one, but one that's been used for a long time, though become more common since Reagan. Since then the parties of the president have reversed 3 times. They also note that it's use peaked with approximately 1200 bill challenged durint Bush Jr's two terms, somewhat redeeming the healine.

It seems that basically presidents have found a way to get a line item veto. I remember various presidents particularly Bill Clinton trying to get a line item veto passed but it never worked. Personally I'd rather see them give the president a line item veto so the process is more transparent. I'd also rather see ALL political donations itemized and enumerated on the web so donations have total transperency too. I'll keep dreaming.

It also reminds me of the interprative philosophy of judical interpretation. The most prominent example being the use of the "just and necessary" clause as a sort of carte blanche for judicial decisions. It seems a little suspicious to me, but it's difficult to pass judgement. I'm not a lawyer or a politician. I think it's just good for us citizens to be informed.