NYT: The Obama Health Care Plan by Atul Gawande, surgeon at Brigham and Women's Hospital, Boston

[flpoljunkie]

Closing paragraphs, italics mine. Very interesting, in the first paragraph, how European countries provide universal care through multiple private insurers.

The Obama Health Plan
By ATUL GAWANDE
Published: May 31, 2007

This is what that road looks like. It is not single-payer. It instead follows the lead of European countries ranging from the Netherlands to Switzerland to Germany that provide universal coverage (and more doctors, hospitals and access to primary care) through multiple private insurers while spending less money than we do. The proposals all define basic benefits that insurers must offer without penalty for pre-existing conditions. They cover not just expensive sickness care, but also preventive care and cost-saving programs to give patients better control of chronic illnesses like diabetes and asthma.

We’d have a choice of competing private plans, and, with Edwards and Obama, a Medicare-like public option, too. An income-related federal subsidy or voucher would help individuals pay for that coverage. And the proposals also embrace what’s been called shared responsibility — requiring that individuals buy health insurance (at minimum for their children) and that employers bigger than 10 or 15 employees either provide health benefits or pay into a subsidy fund.

It is a coherent approach. And it seems to be our one politically viable approach, too. No question, proponents have crucial differences — like what the individual versus employer payments should be. And attacks are certain to label this as tax-and-spend liberalism and government-controlled health care. But these are not what will sabotage success.

Instead, the crucial matter is our reaction as a country when the attacks come. If we as consumers, health professionals and business leaders sit on our hands, unwilling to compromise and defend change, we will be doomed to our sliding global competitiveness and self-defeating system. Avoiding this will take extraordinary political leadership. So we should not even consider a candidate without a plan capable of producing agreement.

The ultimate measure of leadership, however, is not the plan. It is the capacity to take that plan and persuade people to find common ground in it. The politician who can is the one we want.

http://select.nytimes.com/gst/tsc.html?URI=http://select.nytimes.com/2007/05/31/opinion/31gawande.html&OQ=_rQ3D1Q26hp&OP=f00b7c7Q2FQ2AQ23YjQ2AQ5EDvbbQ5EQ2Ap33Q3CQ2A3BQ2AXfQ2AbJ,a,baQ2AXfRKQ23Ka

[endarkenment]

1. What the good doctor didn't tell you.

In germany:
"Ninety percent of the population is covered by comprehensive health insurance funds - so-called "sickness funds." These funds have been in existence since being established by Chancellor Bismarck in 1883. Private insurance covers 9.5 percent of the population, and 0.5 percent, the very wealthy, pay for health care individually."
http://findarticles.com/p/articles/mi_m0843/is_n4_v19/ai_13240427

In the netherlands:
"Historically and politically, Holland has defined health care as a social good. Of the 15 million inhabitants, 9 million are insured by "sickness funds" and 6 million are privately insured."
http://findarticles.com/p/articles/mi_m0843/is_n4_v19/ai_13240427

I didn't have a chance to dig up the facts on the swiss. By the way the Dutch aren't too happy with their system or its measured results (17th in ranking.)

"A report by the World Health Organisation in 2000 ranked the Netherlands 17th in the world for the quality of its health services. The OECD too has scrutinised the Dutch healthcare system and several reports comparing the Dutch situation with other countries have been produced in the Netherlands. All of them have sparked much debate in the Dutch press and among academic circles."
http://www.oecdobserver.org/news/fullstory.php/aid/567/The_Dutch_model.html

[flpoljunkie]

3. Here is an explanation of Holland's "sickness funds" for those, like me who are unfamiliar with it.

How the system works

All patients must pay for health insurance. There is a social insurance scheme ('sick fund'), which covers about two thirds of the population. Those on higher incomes (above about £20 000 a year) must insure privately on the basis of risk, but premiums are tax deductible. Both schemes are administered by about a dozen health insurance companies, which roughly cover a province each.

Their total budget is set by central government, and the fees that doctors can charge are tightly controlled by the Centraal Orgaan Tarieven Gezondheidzorg (COTG). Socially insured patients must first consult their general practitioner, who will treat or refer them appropriately. Privately insured patients have the option of making an appointment directly with a specialist if desired. Both pay almost the same fees. General practitioners usually work in joint practices, as in Britain, running their own financial administration. Specialists are usually self employed but work in association with a hospital, occasionally seeing patients elsewhere in a private practice. In both cases the specialists organise their own administration, though in hospital this is increasingly delegated to the finance department for a fee. In recent years central government has set a macrobudget for the insurance companies, which have in turn set similar constraints on the hospitals and specialists. This has, needless to say, caused a lot of resentment, especially where demand exceeds budget because of advancing therapeutic possibilities or a growing elderly population.

http://www.bmj.com/cgi/content/full/316/7143/S2-7143

[dflprincess]

2. The problem with "income-related" subsidies

is that the income levels are usually unrealistically low - especially for people under 65 with no dependents. They also neglect to consider all a person's expenses. They may look at rent and utilities, but they don't ask about groceries, commuting expense or what it costs to clothe yourself or your kids.

[flpoljunkie]

4. Agree that it is crucial the "income-related" subsidies are not unrealisticially low.

We must demand realistic income levels for these health subsidies so that we can achieve universal coverage--or damn close to it!

[Manifestor_of_Light]

5. How do you pay premiums if you don't have a job, and no prospects of getting one? n/t

[flpoljunkie]

6. No prospects of getting one? Do you mean disabled, and unable to work?

[flpoljunkie]

7. Dr. Gawande also says he would take almost any system-from Medicare to private voucher system

As a surgeon, I’ve worked with the veterans’ health system, Medicare, Medicaid and private insurance companies. I’ve seen health care in Canada, Britain, Switzerland and the Netherlands. And I was in the Clinton administration when our plan for universal coverage failed. So, with a new health reform debate under way, what I want to tell you in my last guest column is this:

First, there is not a place in this world that is not struggling to control health costs while providing high-quality, easily accessible care. No one — no one — has a great solution.

But second, whether as a doctor or as a citizen, I would take almost any system — from Medicare-for-all to a private insurance voucher system — over the one we now have. Job-based insurance is bleeding away the viability of American businesses — even doctors complain about the cost of insuring employees. And it has left large numbers of patients without adequate coverage when they need it. In the last two years, for example, 51 percent of Americans surveyed did not fill a prescription or visit a doctor for a known medical issue because of cost.

My worry is less about what happens if we change than what happens if we don’t.

This week, Barack Obama released his health reform plan. It’s a puzzle how you are supposed to regard presidential candidates’ proposals. They are treated, by campaigns and media alike, as some kind of political G.P.S. device — gadgets primarily for political positioning. So this was how Mr. Obama’s plan was reported: it is a lot like John Edwards’s plan and the Massachusetts plan signed into law by Mitt Romney last year; and it has elements of John Kerry’s proposal from four years ago. In other words — ho hum — another centrist plan. No one except policy wonks will tell the proposals apart from one another.