16 June 2009

Health Care: the Public Plan

If you are interested in the health-care debate, then you need to be interested in the details. Because it's all in the details: grand policy statements and vague notions about ideals are almost entirely useless in this discussion, given the incredibly misleading activity of the GOP, the American Medical Association (which is behaving more like the union it is than the advocacy group it has been), and the farthest left.

If you want the skinny, then Ezra Klein at the Post has a (famous at this point)pretty good primer on some of the public options. Krugman chimed in at the Times with his best efforts at a tidy narrative. But the best discussion is coming from Frank Pasquale at Balkinization, with his series of posts (one, two, and three) analyzing the nature of the public plans and addressing criticism carefully. It's an invaluable read:
Congress or HHS or state insurance commissioners could try to outlaw or restrict risk selection practices one by one. But as Pollitz has noted, as of 1997, the "US Department of Labor had resources to review each employer-sponsored group health plan under its jurisdiction once every 300 years." The Bush years probably did not significantly address that shortage. Moreover, "state insurance department staff levels declined 11% in 2007 while premium volume increased 12%." The personnel simply aren't there, and when they are, they are as likely as not to be outgunned by private sector attorneys, lobbyists, and experts-for-hire. The right way to discipline private insurers is to have competition from a public option--not to allow them to continue a risk-selection race-to-the-bottom by deflecting regulation.
Check it out.

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