Tuesday: Health Plans
In keeping with yesterday's 'issues' (though rather ranty) post on the economy, today let's talk about the health plans proposed by the campaigns. Health Affairs, a policy journal on the health care industry, has published two independent studies on the proposed solutions to health care and insurance, to determine what the real impact will be on you and me. Now, being journal articles, they are slightly longer than a newspaper article.
Obama Health Plan: More Regulation, Spending by Joseph Antos, Gail Wilensky, and Hanns Kuttner (.pdf file here).
Abstract: The health reform plan put forth by Sen. Barack Obama (D-IL) focuses on expanding insurance coverage and provides new subsidies to individuals, small businesses, and businesses experiencing catastrophic expenses. It greatly increases the federal regulation of private insurance but does not address the core economic incentives that drive health care spending. This omission along with the very substantial short-term savings claimed raise serious questions about its fiscal sustainability. Heavy regulation coupled with a fallback National Health Plan and a play-or-pay financing choice also raise questions about the future of the employer insurance market.
(Aside: If you recall from the primary season debates, this was the one issue where Clinton and Obama differed somewhat significantly. An op-ed critique of the Obama plan by David M. Cutler, J. Bradford Delong and Ann Marie Marciarille, Wall Street Journal: Why Obama's Health Plan Is Better.)
McCain Plan: Transformation, Less Coverage by Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz (.pdf file here).
Abstract: Senator John McCain's (R-AZ) health plan would eliminate the current tax exclusion of employer payments for health coverage, replace the exclusion with a refundable tax credit for those who purchase coverage, and encourage Americans to move to a national market for nongroup insurance. Middle-range estimates suggest that initially this change will have little impact on the number of uninsured people, although within five years this number will likely grow as the value of the tax credit falls relative to rising health care costs. Moving toward a relatively unregulated nongroup market will tend to raise costs, reduce the generosity of benefits, and leave people with fewer consumer protections.
(Aside: An op-ed critique of the McCain plan by Bob Herbert, NY Times: McCain's Radical Agenda.
An examination of both plans in light of Health Affairs' reports by Laura Meckler, WSJ: Studies Detail Contrasts in Rivals' Health-Care Plans".)
Health Affairs also has an article offering a compromise between the two plans: Blending Better Ingredients For Health Reform by Mark V. Pauly (.pdf file here).
Abstract: This paper argues that a desirable health reform plan should accept some features that the Obama and McCain plans have in common, and combine other features from each of the plans. Useful combinations include the presence of both public and private options and a system of credits that are more generous for lower-income households (Obama) and creation of a system of public subsidies that is incentive-neutral across individual and group insurance, curtailment of the current tax subsidy to high levels of coverage for high-income households, and the use of targeted high-risk pools and guaranteed renewability rather than community rating (McCain).
This is an issue that matters to me very much. Many of you know I've been a diagnosed migraine sufferer for several years now, and that health insurance has been out of my reach. The impact on my finances has been significant not so much because of doctor's expenses, but because my medication is ridiculously expensive for a small amount of meds (now reaching nearly $200 for 9 pills of my main med, Frova [frovatriptan succinate], and about $50 less for 6 pills of my secondary med, Amerge [naratriptan]). Two months ago I finally got health coverage with a high deductible/low premium, and a separate low ($500) prescription deductible. The catch? The migraines are considered a pre-existing condition. This means I cannot use my insurance to pay for doc visits or prescriptions for the migraines for six months, ie. until January 2009. They'll pay for anything else except the migraines. If I had any other medical problems, I suppose this wouldn't bother me as much, but then they'd probably categorize those as pre-existing conditions as well. Sure, they'll start paying in January, but in the meantime, they're taking my money for a service I can't use. I shopped around for years, and this was the best plan I could find. I even applied for that PPA plan Montel Williams advocates (it saves me $10 on my prescriptions), and have tried alternative preventative therapies with differing results. At the end of the day, though, when I get a corker of a migraine, the meds are the only thing that stop the pain. But I digress.
So, whose plan suits your situation best?
Obama Health Plan: More Regulation, Spending by Joseph Antos, Gail Wilensky, and Hanns Kuttner (.pdf file here).
Abstract: The health reform plan put forth by Sen. Barack Obama (D-IL) focuses on expanding insurance coverage and provides new subsidies to individuals, small businesses, and businesses experiencing catastrophic expenses. It greatly increases the federal regulation of private insurance but does not address the core economic incentives that drive health care spending. This omission along with the very substantial short-term savings claimed raise serious questions about its fiscal sustainability. Heavy regulation coupled with a fallback National Health Plan and a play-or-pay financing choice also raise questions about the future of the employer insurance market.
(Aside: If you recall from the primary season debates, this was the one issue where Clinton and Obama differed somewhat significantly. An op-ed critique of the Obama plan by David M. Cutler, J. Bradford Delong and Ann Marie Marciarille, Wall Street Journal: Why Obama's Health Plan Is Better.)
McCain Plan: Transformation, Less Coverage by Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz (.pdf file here).
Abstract: Senator John McCain's (R-AZ) health plan would eliminate the current tax exclusion of employer payments for health coverage, replace the exclusion with a refundable tax credit for those who purchase coverage, and encourage Americans to move to a national market for nongroup insurance. Middle-range estimates suggest that initially this change will have little impact on the number of uninsured people, although within five years this number will likely grow as the value of the tax credit falls relative to rising health care costs. Moving toward a relatively unregulated nongroup market will tend to raise costs, reduce the generosity of benefits, and leave people with fewer consumer protections.
(Aside: An op-ed critique of the McCain plan by Bob Herbert, NY Times: McCain's Radical Agenda.
An examination of both plans in light of Health Affairs' reports by Laura Meckler, WSJ: Studies Detail Contrasts in Rivals' Health-Care Plans".)
Health Affairs also has an article offering a compromise between the two plans: Blending Better Ingredients For Health Reform by Mark V. Pauly (.pdf file here).
Abstract: This paper argues that a desirable health reform plan should accept some features that the Obama and McCain plans have in common, and combine other features from each of the plans. Useful combinations include the presence of both public and private options and a system of credits that are more generous for lower-income households (Obama) and creation of a system of public subsidies that is incentive-neutral across individual and group insurance, curtailment of the current tax subsidy to high levels of coverage for high-income households, and the use of targeted high-risk pools and guaranteed renewability rather than community rating (McCain).
This is an issue that matters to me very much. Many of you know I've been a diagnosed migraine sufferer for several years now, and that health insurance has been out of my reach. The impact on my finances has been significant not so much because of doctor's expenses, but because my medication is ridiculously expensive for a small amount of meds (now reaching nearly $200 for 9 pills of my main med, Frova [frovatriptan succinate], and about $50 less for 6 pills of my secondary med, Amerge [naratriptan]). Two months ago I finally got health coverage with a high deductible/low premium, and a separate low ($500) prescription deductible. The catch? The migraines are considered a pre-existing condition. This means I cannot use my insurance to pay for doc visits or prescriptions for the migraines for six months, ie. until January 2009. They'll pay for anything else except the migraines. If I had any other medical problems, I suppose this wouldn't bother me as much, but then they'd probably categorize those as pre-existing conditions as well. Sure, they'll start paying in January, but in the meantime, they're taking my money for a service I can't use. I shopped around for years, and this was the best plan I could find. I even applied for that PPA plan Montel Williams advocates (it saves me $10 on my prescriptions), and have tried alternative preventative therapies with differing results. At the end of the day, though, when I get a corker of a migraine, the meds are the only thing that stop the pain. But I digress.
So, whose plan suits your situation best?