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June 01, 2008

What!? You haven't devised your own health care reform plan yet!?

Hey, everyone's doing it.  In the past week, two new entrants in the health care reform plan derby are AHIP and Ezekiel Emanuel

AHIP's potpourri includes a bunch of stuff that's happening anyway (e.g., better management of chronic conditions), a number of things that probably never will (e.g., tort reform), and some (e.g., EMRs) that may reduce costs or may increase them.  See the AHIP plan in all its glory, and check out Bob Laszewski's discussion at his Health Care Policy and Marketplace Review.  As Bob writes, "They [the insurers] talked a lot about what others need to do but I didn't see a lot aimed specifically at what insurers are willing to sacrifice to bring costs down."  PwC gave the opinion on savings: $145b/year.  (That's a drop in the bucket.)
For a close look at Dr. Emanuel's plan, see Maggie Mahar's two-parter at HealthBeat, here and here.  A very interesting exercise, if you ask me, but one that has virtually no chance of adoption in this country -- the financing mechanism is a 10% value-added tax.

News on other plans out there:

The Massachusetts experiment is taking some heat these days, since costs are way above the expected figures.  Some would say that the Dems are affected by this, since both Democrat contenders have built health care platforms based largely on the Massachusetts model.

Wyden's plan is still looking good.  See Wyden and Bennett's recent piece in Health Affairs, and the recent CBO blessing of the plan.  Savings under this plan aren't much better than under the AHIP plan, and there would be some significant dislocations if this plan were implemented (including dislocations in the health insurance sector, which may have an interest in keeping small groups and non-group business in existence -- something the Wyden plan would essentially end -- perhaps just one of the many reasons AHIP is out there beating the drum for its own particular brand of health care reform).

It remains to be seen whether there is any appetite at all for comprehensive reform after the election.  My gut continues to tell me: incrementalism, baby.

-- David Harlow


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