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If Democrats are looking for a political “win” on health care reform and a brand new bill that would be easy to sell to American people, one option is a reconciliation-only bill that just provides block grants to states. The concept is very simple. Democrats would decide how much they wanted to spend (say, $600 billion), and then spend it as block grants given to states to figure out their own way to deal with health care reform. Ideally, the block grant would come with a waiver to ERISA laws to give states more flexibility.
The idea is simple, clean, and easy to explain. The whole bill would only need to be a few pages long. It would simply give money to each state based on some formula for the states themselves to decide how best to increase insurance coverage. The block grants would come with only a few restrictions that the money only be used to increase insurance coverage and insurance quality. Politically, the idea is difficult to attack because there are no details to attack, that is all left to the states.
How states use the money would be up to them. It could be Medicaid expansion, Massachusetts style exchanges with subsidies, expand programs like Washington’s basic health plan, a system that subsidizes employer mandates, a universal basic care program through massive expansion of community health centers, a universal, state-run extreme catastrophic insurance plans, etc. It would be smart to include a bit of a stick to encourage states to act. For example, after one year, if the state fails to pass a law to deal with their block grant, it would automatically be directed to a modest Medicaid expansion in the state.
Democrats would promise that after five years there would be an evaluation of each state’s ideas to see if any state or group of states should serve as a model for further reform. It could be sold as the right response to Republican complaints about a “one size fits all” solution, and complaints about how the bill is too long and hard to understand.
Policy-wise, this is far from an ideal solution, but, politically, it might be the simplest and least unpopular path for the Democrats to achieve something big on health care reform. It is easy to understand and easy to explain. It would allow Democrats to say they listened to the American people, and changed in response to the complaints they heard. Most importantly, from a political standpoint, the idea would be for states to quickly expand existing programs that they already have to help the uninsured. If this new bill started helping people right away, instead of four years from now, it might convince Americans that the Democrats controlling Washington are actually passing laws to help regular Americans.
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TOTAL COP-OUT!!!
That’s a really good idea Jon, sucks for those of us in Red States… but I’ll take one for the team. :o)
I would only add the suggestion that states be allowed to buy into existing federal coverage plans, The only stipulation should be that the coverage costs would be borne solely by the State-directed funds (whether general revenue, block grants, individual premiums or mandated employer contributions). While Medicare, Medicaid and SCHIP are the best known federal plans, the best plan in terms of coverage and ease of expansion is the Pentagon’ public option for military reservists and their families, Tricare Reserve Select (or the similar CHAMPVA, the VA’s single payer system for families of disabled vets).
Tricare’s administrative costs are higher than they should be since it administered through private contractors, but for one premium (unsubsidized, $179 a month for an individual, $704 a month for families), Tricare offers low annual deductibles and copayment caps ($50/$100 deductibles for individuals/families, $1000 copayment cap for either) and covers hospitals and providers at Medicare rates and prescription drugs at VA prices.
In contrast, for similar coverage under the Medicare system, it’d be split up into 4 policies and presumably 4 premiums for a buy-in, Part A (hospitals), Part B (providers), Part D (drugs) and a private Medigap policy to provide a catastrophic cap. And of course, Medicare has no provision to provide family coverage, so each family member would have to pay their individual premiums separately. Even if the total cost were the same, can you imagine the public reaction to requiring a family of four to write 16 (!!!) Medicare/Medigap premium checks a month versus paying just one monthly premium to Tricare?
I do not advocate for any one idea. This is my 4th post I believe on the matter of what you could do with a reconciliation only bill. It is important for people know there exist the possibilities beyond what is currently being talked about.
Don’t see that flying. I know I wouldn’t want to leave it up to the states. There are states where the governor’s brother-in-law would be getting contracts to provide “health services”
And yet its still a very good idea (though your proposals usually are). The best part, politically, is the implicit “state’s rights” argument– if California wants to give its citizens a “socialized medicine” government plan, they can do so with federal assistance and it won’t impact MIssissippi in its quest to give as much corporate welfare as possible to insurance companies. Such a “state’s right bill” (and it is fun using a reactionary label to promote a progressive goal) would put conservative in the position of voting to deny their own state the authority to set its own healthcare policy, they must think Washington knows better. :o)
It will create an unstable political situation of course. Eventually either Mississippi will elect a governor and legislature who’ill wise up and follow the lead of liberal states that provide every citizen an efficient government plan, or (and more likely), Congress will come back and move the “public option” decision from the state level down to the individual level. In the meantime, conservatives will have a chance to prove the rest of us wrong by unleashing the power of, umm, “free market” healthcare reform in Red States. If they have the courage of their convictions, that is.
Is FDL going to be part of the new public option whip effort starting now?
This is supposed to be a FEDERAL Plan for the MIDDLE CLASS!!!!!!! That’s the majority of who need Healthcare Reform. The states already have their own failing plans.
Jon, I think this an attractive proposal, especially with some of the embellishments suggested by Beowulf. States that are now interested in Medicare for All: California, Pennsylvania, Minnesota, and Vermont, could go ahead and try it. Others could use Beowulf’s buy-in. Still others could experiment with other ideas. From the viewpoint of people who favor Medicare for All as the eventual solution for health care reform, this approach would represent progress that would not prevent further progress down the road. So, I think it would get the backing of groups supporting a single-payer solution.
Local programs (essentially Co-ops) have proven not to reduce costs, and in fact increased costs, in VT, TN and MA.
Localized risk pools are WAY too small for Reform-scale cost reductions, and additionally, if based on private insurance, far too easily corrupted.
Only a National Government plan, available to all, would reduce costs TO THE PATIENT significantly. But it would be SIGNIFICANT indeed.
Even if a small start (Public Option) is the most we could get, at least it has to be a national-scale risk pool, and large enough, which means available to all (at least) as a choice. Without this minimum, a mandate to buy private insurance (defined as unregulated without this minimum limitation) is madness, and would result in something even worse than political suicide.
With it, however, a mandate makes sense, to force the young and healthy into the pool for diversity as well as numbers. And with that, the cost could be extremely low, and the restrictions nonexistent (they only add to the cost anyway.) Considering Medicare’s currently if-separate-fund SURPLUS produced at $90-100/mo. even with a HIGH risk-Sr. Citizen only- risk pool; I’m guessing with the new larger pool premiums between $50-$75/month, with NO restrictions or copays/deductibles, would not be unreasonable to expect!
Remember Europe (see T.R.Reid) has found that it costs MORE to ADMINISTER EXCLUDING anything or anyone, than simply to cover everything and everyone. This would horrify a for-profit company, but is absolutely true with profit out of the picture. It’s time for an END to the “Uniqely American Solution.” It’s simply too wasteful, and inhuman to boot.
Private Profit has no place in Health Care.
It’s logically a Protection Racket.