Florida Health Insurance Topic:
"Insurance Questions Most Asked"

Health Insurance Advice from Broker

Q:: Are private health insurers the best to achieve universal coverage?

A:: Yes. They already know what they're doing. -- Maybe, if they're forced to keep prices down. No. Their track record speaks for itself.

The loophole was included -- "hidden" is a more apt word -- in a letter sent to prominent senators from a pair of industry leaders: Karen Ignagni, president of America's Health Plans, an industry group; and Scott P. Serota, president of the Blue Cross Blue Shield Assn.

The letter featured insurers' willingness to adopt a more inclusive coverage policy in return for "an effective, enforceable requirement that all Americans assume responsibility to obtain and maintain health insurance."

In other words, a government mandate that everyone become the industry's customers. That's not quite as self-serving as it sounds. Universal coverage is feasible only if the insurance risk is spread among the entire population, thus making coverage affordable for everyone. A government mandate will probably be part of any healthcare reform solution.

But Ignagni and Serota go on to say, almost in passing, that "benefit design" will be needed to keep policies affordable. That's insurance-speak for offering bare-bones coverage at relatively low prices and more complete coverage at higher prices -- basically the same sort of system we have now.

"We're telegraphing that if people are allowed to buy more, then it will cost more," Ignagni told me. "You wouldn't charge the same for a Cadillac as you would for a Ford."

The danger, however, is that younger, healthier people would probably gravitate toward the cheaper basic policies, while older people with more health issues would feel compelled to buy the more comprehensive plans.

"It's a very potent way of segregating sick people from healthy people," said Karen Pollitz, a research professor at Georgetown University's Health Policy Institute. "It's essentially a way of continuing to charge more based on people's health."

Which is exactly what the insurers are saying they won't do in return for that much-desired government mandate.

I'll give the insurance industry credit for coming to the table with something halfway constructive, even if it took them decades to get there. But let's be realistic.

If all Americans were required to purchase health insurance from private companies, the industry would still offer as little coverage as possible for the most amount of money. These people have businesses to run, after all, and their track record speaks for itself.

A mandate would benefit the industry, and it could help address the shameful problem of nearly 46 million people in this country now lacking health insurance.

But it wouldn't guarantee the best possible coverage for the public. Nor would it improve things for the millions of people who have insurance but are still one catastrophic illness away from bankruptcy.

To solve these problems, we'd need clear criteria from the government as to what should be covered and at what prices. And if we're going that far, I have to wonder why private insurers even need to be part of the equation.

President Obama has said he's interested in the idea of the federal government offering some sort of public insurance program that would compete with private insurers.

But in an online town hall Thursday, he said he favors keeping the employer-based system that has provided coverage for most Americans since World War II. "I don't think the best way to fix our healthcare system is to scrap what everybody is accustomed to," he said.

The president should take a closer look at the insurance landscape. More than half of all Americans are already covered by -- and thus accustomed to -- public coverage in the form of Medicare, Medicaid and veterans assistance. We're already well down the road toward fairly priced universal coverage. We just need to make it the rest of the way. If private insurers want to be part of that process, they'll need to be a good deal less disingenuous than they were last week.

Retiree Care to Rise

Deflation? It hasn't shown up yet in retiree medical costs.

In a new study, Fidelity Investments estimates a couple retiring this year can expect to shell out a combined $240,000 on average for health care over their remaining lives. The study assumes both spouses are 65, the husband will live 17 more years and the wife 20 years, and that neither spouse qualifies for employer-provided health coverage but both qualify for Medicare.

The 2009 figure is up 6.7 percent from an estimate of $225,000 in health costs for people retiring last year.

According to the study, health care is likely to be the largest expense in retirement for most people. Of note, Fidelity's estimate excludes over-the-counter medications, most dental services and long-term care.

Fidelity recommends saving specifically for health needs and seeking preventative care to lessen long-term costs. Retirees should also check medical bills for accuracy, consider supplemental health insurance and research providers.

LazaBrkonja Comments::

Unfunded Medicare costs - that means costs the Federal govt has agreed to pay but doesn't have any money set aside for - amounts to over $34 TRILLION right now. (source- IOUSA.com)

Should have never been something that the govt provided. No way we can pay it....never was. The promise was only good for votes.

Now everyone can understand why BO and the Dems want to nationalize health care. Since they know that there's no way to pay for the health care, they need to control it all so they can make determinations as to what (and whom?) is going to be treated. Who lives and dies will be in the hands of the govt....if they're allowed to continue down the path they have started.

Don't believe it? Didn't believe that the govt would tell GM who could be their CEO either I imagine.

Bloomberg & Obama on Health Care

During his visit to Washington, D.C., on Tuesday, New York City Mayor Michael R. Bloomberg reinforced his support for President Obama’s comprehensive national health care reform, and urged both Republican and Democratic mayors to support this initiative and work toward finalizing the plan in 2009.

He also urged federal government to draw from New York City’s health reform experience, and to address increasing health care costs and the growing number of people without health insurance.

On Wednesday, the Mayor reviewed New York City’s health reform initiatives to promote wellness, disease prevention and improved patient care at the Ryan-NENA Community Health Center in Manhattan. He also highlighted NYC’s efforts in increasing accountability and transparency of the health care providers and investing in innovative technologies.

“President Obama has identified critical nonpartisan principles that should guide any health care reform package and I support his push to enact comprehensive health care reform this year,” said Mayor Bloomberg. “Our challenge is to keep Congress at the table until they come up with a workable solution—and commit to not walking away when the going gets tough,” he continued.

“We need to ensure that federal reform strengthens and meets the needs of immigrants. At the same time, we will continue to advance our innovative efforts here in New York City to reduce smoking, encourage healthy food choices, and invest in health information technology,” further noted the Mayor. “We’ve heard a lot about how government has to step in when a company is ‘too big to fail.’ This push for health care reform is too important to fail. It’s too important to our cities. It’s too important to our nation. It’s a challenge we can’t flinch from—and it’s an opportunity we must seize,” he added.

George Gresham, president of 1199 SEIU United Healthcare Workers East, voiced his support by stating: “We are proud to stand with Mayor Bloomberg today to support President Obama’s health care reform agenda. The President's reform agenda will help over 2 million uninsured New Yorkers gain health care coverage. During this economic crisis, it is more important than ever that we protect working families who have lost their jobs and benefits by providing them with access to quality healthcare.”

Take Care New York initiative was implemented in 2004 to promote public wellness and disease prevention. Through its identification of action-oriented goals to aid NYC residents in improving their health, the program reported surpassing its 2008 targets in colon cancer screening, primary health care access, tobacco smoking, and intimate partner homicide as early as 2007.

“New York City is a leader in developing innovative, pragmatic programs which help to tackle some of our most complicated urban challenges like poverty, improving access to primary care physicians, and expanding healthy food choices,” said Deputy Mayor for Health and Human Services Linda I. Gibbs. “But we need our federal partners to enact comprehensive healthcare reform to address the growing numbers of uninsured and underinsured New Yorkers and to bolster our safety net.”

New York City also invested in the nation’s largest primary care electronic health record (HER) community network, by providing prevention-focused EHRs to over 1,100 doctors who treat over 1 million patients in low-income communities. President Obama has included over $20 billion for EHRs in the federal stimulus funding, since national estimates show that only less than 2 percent of hospitals currently use comprehensive EHRs. These records enable doctors efficient access to information regarding patient vaccinations, screenings and other preventative disease controls, as well as enable them to track success rates in preventative measures across their patient populations.

“New Yorkers are living longer, healthier lives today because New York City invested in programs that reduce preventable illness and death,” said Health Commissioner Dr. Thomas Frieden. “By creating a comprehensive public health and health care policy, and promoting electronic health records for primary care physicians, we are focusing on what works and saving lives.”

As part of the public hospital system’s transparency initiative, the New York City Health and Hospitals Corporation (HHC) has voluntarily reported health and safety outcomes, such as infection and mortality rates across its participating hospitals on the City’s website (www.nyc.gov/hhc).

The 2008 data showed that HHC’s mortality rate decreased by 13 percent since 2003, and continued to be below the national benchmark despite an increase in the acuity of patient cases. Its infection rates in the intensive care units across 11 participating hospitals have decreased for 3 consecutive years, with a 90 percent decrease in ventilator-associated pneumonia infections and a 65 percent decrease in the central line bloodstream infections. The decline in infection rates represents over 1,000 prevented infections prevented and approximately $16 million saved in healthcare costs.

“Greater access, more transparency, robust primary and preventive care, wide-scale use of electronic health records, and more effective chronic disease management are all priorities of the Obama administration reform agenda,” said HHC President Alan D. Aviles. “They also have been the hallmark of our transformed New York City public hospital system.”

The William F. Ryan Community Health Network was also established to provide access to affordable primary and preventive health care across New York City’s medically underserved communities. Approximately 85 percent of patients who benefit from this program fall below 200 percent of the federally defined poverty level.

“No other city has put public health at the forefront like New York City has, and we are proud to work with Mayor Bloomberg and his administration to expand the availability of quality and affordable healthcare to those who need it,” said president and CEO of the William F. Ryan Community Health Network Barbra E. Minch. “The Ryan Network’s guiding principle is that health care is a right, not a privilege—and what we are seeing today is a renewed commitment by our local and national leaders to help fulfill those goals for all New Yorkers.”

Medical Choice?

A recent poll from CBS News found that the tightening economy is forcing people to make some tough choices. Alarmingly, these kinds of decisions are spilling over into an area where they don't belong -- health care. More than one in three Americans is delaying care. Around 30 percent are skipping screenings, tests, and other treatments. And 27 percent aren't filling their prescriptions.

In the most advanced and wealthiest nation on earth, people should never have to make these kinds of choices with their health. It's as clear a sign as any that our current healthcare system is overdue for an overhaul -- and I've spent over 30 years analyzing opinion polls.

But fixing our broken healthcare system presents a huge challenge -- one that can't be solved through partisan politics. If it could, we'd have fixed the problem long ago.

The simple fact is neither side has the complete answer. As a centrist committed to nonpartisan solutions, I'd like to offer some middle-of-the-road approaches that bare serious consideration.

First, we need a renewed emphasis on disease prevention. Promoting wellness and healthy lifestyles is a lot cheaper than paying for someone's hospital care. Prevention campaigns, like those spearheaded by Mayor Bloomberg in New York, will pay huge dividends in the future for everyone.

The obesity epidemic, for example, is ravaging the nation -- the Centers for Disease Control estimate more than one-third of all adult Americans are obese. Obesity drives up healthcare spending and costs untold billions of dollars in lost productivity.

Fighting obesity, particularly in children, will, in the long run, reduce healthcare costs and strengthen our economy. But it will require a joint public-private approach just like the successful efforts to reduce and curb smoking.

Public and private partnerships shouldn't end there. While most Americans agree that the eventual goal of healthcare reform should be universal coverage -- that is, health insurance for all -- there is more than one way to get there. The political right generally opposes completely government-run health care, and the left distrusts the private sector to get the job done by itself.

But a public-private partnership, similar to the very successful and lauded healthcare systems in the Netherlands and Switzerland, may strike the right balance between privately-organized but publicly-guaranteed health insurance.

Our government already has effective programs in place to identify and enroll the 12 million Americans currently without any health insurance yet eligible for Medicaid and the State Children's Health Insurance Program. But only privately-run insurance plans have the experience, ability, and impetus to push the healthcare system forward to innovate and adapt. Indeed, the insurance industry is ideally positioned to address the uninsured crisis.

Government can also create new pooling mechanisms to extend health insurance to the self-employed, small businesses and the poor, and private health plans should compete for the business of those groups, working to generate both affordability and expanded access.

Government alone can't solve these problems. Nor can private industry. But working together, we can find the right innovation and infrastructure to effectively reform the system. From a renewed emphasis on prevention, early detection, and intervention to expanding the public safety net that will catch the neediest members of our society.

The healthcare crisis is not some incurable disease. It can be treated -- jointly -- with the best of private industry and the best of public programs.

Single-payer System -- A Good Start

The delivery and financing of healthcare is complicated business, and we don’t claim to know definitively what system would be best for the greatest number of Americans. What we do know is that the system we have doesn’t work, that costs are rising far faster than incomes, that it makes no sense to burden private business with having to provide care for the workforce and that a for-profit insurance model encourages the denial of treatment.

Without question, we’d like to see a swift shift to a national healthcare system that eliminates the profit motive, cuts out the money-sucking middlemen and allows businesses to focus on what they do and frees them from the crushing burden of financing medical care.

But we’re not the ones who have to sell the idea to an electorate that shudders at the mention of “socialism” and to elected officials who are terrified of those voters, or dodge the stones and arrows of the Rush Limbaughs of the world and stand up to the powerful medical, insurance and pharmaceutical lobbies that help finance campaigns.
That job belongs to President Barack Obama, who is in the process of rolling out a basic framework for national healthcare reform. Sadly, political realities make it imprudent to propose a seismic shift in the way healthcare is delivered and paid for, but from the sound of it, he’s taking baby steps in the right direction.

Obama wants to make medical care accessible to the roughly 46 million Americans who have no insurance. Yes, that’s 46 million people — 15 percent of the U.S. population — who can’t get basic and preventive care and must rely on expensive emergency-room care. He suggests financing the plan through a variety of means: reducing the value of itemized tax deductions for the nation’s top earners and ending George W. Bush’s tax cuts for the rich, and forcing private Medi-Cal providers to compete for the government’s business.

That last idea gives us hope that Obama won’t shrink from the insurance lobby.

If the insurance companies fight back, Obama has got to get tough — really tough — and use his considerable rhetorical skills to give the public some straight talk about the role of private insurance in the healthcare system. In other words, he needs to do what Michael Moore has tried to do but doesn’t have the gravitas or public popularity to effectively pull off. Conservatives love to say the doctors and patients should retain the ability to make decisions about medical care, but they don’t have that ability now; pointy-headed insurance-company paper jockeys do, and their masters are company shareholders.

We’re not so naïve to think that once private insurance is removed from the system, all will be hunky dory in Healthcare Land. Conventional wisdom has it that what’s driven up the overall cost of healthcare so dramatically is progress in medical technologies and treatments—high-tech equipment and designer drugs.

Even a single-payer, government-run system free of marketing expenses and outrageous executive salaries would have to contain costs so that taxpayers are reasonably charged, and, frankly, we’re not sure how to do that without some kind of tiered system in which people with money pay more for care that’s considered a luxury rather than essential and basic. And who decides what is essential care and what is not?

A writer for the blog Stubborn Facts not long ago used costly ACL surgery and the cholesterol-lowering drug Lipitor as examples of new-ish care that might not be essential. Like everything in this arena, that’s debatable.

In any case, we’re frustrated by claims that the country can’t afford a national healthcare system. It’s not like we’re not paying dearly for the broken private system we have now—the one in which the rich get excellent care, the shrinking middle class gets increasingly inadequate care and too many people get none at all, increasing the long-term cost for the rest of us.

For the long run, why not just convene a team of three healthcare economists to determine how much it would take to provide every American with preventive and essential care and come up with an equitable way to spread the cost among the taxpayers? Would that be so hard?

Meantime, we applaud the president for standing up to the status-quo crowd.

Illinois -- One Step Closer to Health Insurance

The record number of people who've lost their employer-sponsored health insurance, forced into the private market where they struggle to get the care they need -- received good news last night, they are one step closer to having a new law on their side. Legislation establishing stronger consumer protections in the private health insurance market passed the Illinois House Health Care Availability and Access Committee.

The Health Insurance Consumer Protection Act (House Bill 3923), introduced by State Representative Greg Harris (D-Chicago), addresses key barriers facing consumers who struggle with unfair and inconsistent industry practices. The legislation is being heavily opposed by the health insurance industry.

"Unfair practices in the insurance industry have put up a wall between people and their health care," said Bob Gallo, AARP Illinois State Director. "AARP commends Representative Harris for his leadership on this critical issue."

The Individual Health Insurance Fairness Act would:

-- Require insurance companies to spend at least 75% of premium dollars on medical care rather than on executives' salaries, marketing, and profits.

-- Establish an Office of Consumer Health Insurance to conduct external independent reviews of denied claims and rate increases.

-- Simplify the complicated application process for both individual and small group markets by creating a standard application, making it easier for them to get coverage.

"The insurance industry is working hard to defeat this bill and keep the people of Illinois from the insurance reforms they deserve," added Gallo. "Getting this legislation signed into law is AARP's top priority and we urge the State House to pass it."

Nationally, nearly 4 million people have lost their health care since the recession began, while roughly 17 million purchase their own coverage. In the private market, an average annual premium for a family of four has risen to nearly $5,500, while an individual premium costs $2,500 in Illinois. A recent AARP study found that adults aged 50-64 spend roughly 10% of their income on health coverage, and paying three times as much as their peers with employer-sponsored coverage.

Considering Government Healthcare Reform

There is a need of an urgent and comprehensive health care reform in the United States of America and a number of organizations like the National Small Business Association (NSBA) have been vibrant proponents of this concept. Now it’s the turn of a panel of experts which is also giving voice to the same demand. What is the consideration of this group therefore?

According to the group, it’s high time for the government to initiate precise efforts to overhaul the U.S. healthcare system and only that can lead to the inclusion of essential maneuvers that provide better access to good food and recreation. It has also been concluded by the panelists in the report commissioned by the nonprofit Robert Wood Johnson Foundation that there is the need of innovative thoughts. Take for instance, the concept of providing requisite medicines and food to the sick people is normal and this also leads to the calculation of costs. But the panelists consider that it is more important to give people in schools and cities better access to nutritious food and places to exercise.

Speaking on this, Jim Marks, head of the foundation’s health group, which funds projects and research aimed at improving healthcare made it clear, “It’s clear that as a nation we have tried to spend our way to better health through medical care, and it hasn’t succeeded.”

What has been the government’s response? Well, both of Congress and White House, according to latest information, are taking stock of the reality and are therefore gearing up to refurbish healthcare delivery and insurance coverage. It is to be noted that the US President Barack Obama has made providing health insurance to the 46 million Americans without it a cornerstone of his plan, seeking a 10-year, $634 billion reserve fund as a “down payment” for the effort.

It has also been learnt that Congress is planning related legislation and has adopted steps to insure some children and boost electronic medical records.

HHS Health Care Report

Americans expressed serious concerns regarding health care in a new report released today by the Department of Health and Human Services. The report, Americans Speak on Health Reform: Report on Health Care Community Discussions, summarizes comments from the thousands of Americans who hosted and participated in Health Care Community Discussions across the country and highlights the need for immediate action to reform health care.

The report is available on a new Web site dedicated to health reform: www.healthreform.gov. Unveiled today, the Web site will allow Americans to view today’s White House Health Forum, share their thoughts about health reform with the Obama Administration and sign a statement in support of President Obama’s commitment to enacting comprehensive health reform this year.

What Do You Think About Health Insurance?

What do you think? Do we have a right as Americans to have access to affordable health care or is it only for the wealthy and employed. Let's start with the basics. You may be vaguely aware that your tax dollars support health care for the disadvantaged, its called Medicaid. Your tax dollars also support Medicare, health care for the elderly and disabled. The health care system is beginning to split at the seams, I'll explain.

If you are in the vast majority of Americans you are not independently wealthy and probably have employer subsidized health care. Even if you can afford insurance without employer help, chances are the cost cuts deeply into your vacation fund every year. As your employer helps you with health insurance, your taxes help pay for Medicare and Medicaid. Unfortunately, the entire system is out of balance. An insurance pool, which is any group of people or things (homes, cars) insured for any reason, must have balanced risk.

What the heck does that mean?

It means an insurance pool (health insurance in this case) must have enough healthy people paying into the fund to pay for the sicker people using the insurance resources. In this model we share the risk equally. Right now this is not how it works in America. Private insurers ( the one you have at work) only want the healthy people. You may have noticed how hard it is to get private insurance if you have a pre-existing condition and don't have current insurance. Remember the sicker group of people that use the resources? The are mostly on Medicare if they are over 65, under 65 they are on Medicaid if they qualify.

Florida had to adjust its budget (place more money in Medicaid than planned) to qualify for the most Federal Stimulus possible. Should we not be funding Medicaid according to a standard? A Federal standard perhaps?

Is this any way to run a Health Care System? While we consider ourselves unique here in America, there is nothing unique about our health care system. It is poorly distributed and costs all of us too much money and gives us too little health care often too late. There are many models across the first world countries( not just Canada and Britain) that do a great job of caring for people, paying the health care providers what they are worth and cost less than our system.

Hmmm...... what is up with America?

Do you believe that your neighbor's child should die from cancer because his father lost his job? Should a young couple, both with jobs, have to take a loan to pay for the birth of their child? What will happen to you when you need care that your insurance won't cover and you can not afford? I think it is time we had a discussion with ourselves about how we should treat each other as Americans.

Need To Fix Health Care Now

During his first official conference with the heads of other major industrialized nations, Barack Obama is dealing with questions about America’s responsibility in the economic crisis currently gripping the world. Whether fair or not, delegates are pointing a collective finger in the direction of the newest delegate to the G20 union.

As always, the self-controlled Obama emphasized the need to move forward and look for solutions, rather than looking back to place blame. In the end, he explained that responsibility must be shared by all.

One problem the rest of these countries have long managed that we have yet to confront is health care. The rest provide their citizens with low-cost health care, while medical debt is responsible for roughly half the bankruptcies in the United States. Health care is right up there with unemployment and global warming as primary issues that must be addressed in order to solve our overall problems.

Some people fear that dealing with so many things at once will lead to failure in one or more areas. Obama counters by explaining that American families must deal with multiple problems at once, so why should the country be any different? But conservatives remain adamantly opposed to handing over more control to the government in this most personal service.

The argument is reminiscent of John McCain’s campaign claim that the problems of uninsured people and the high cost of medical services can be corrected by "market forces." Republicans ignore the fact that "market forces" caused the mess in the first place. They argue that depending on government to solve the problem will put medical decisions in the hands of bureaucrats, while we suffer from the current practice of allowing insurance company executives to deny medical care to people who need it, while receiving fat bonuses for performing that odious task.

Whenever McCain sounded the warning about government employees making "decisions" about our health care, I remembered that he's received government-administered medical care every day of his life. I never heard him mention the terrible experience he's had in the delivery of poor medical care or being denied necessary care as a result of any decision made by a government employee. He seems to be in excellent shape for a man of his age who was so badly injured during his North Vietnamese internment and has survived multiple cancers. I always wondered how McCain could say we'll receive care that is worse than the government program he seems to have benefitted from so well.

McCain wanted insurance to be portable between jobs but never mentioned how people would pay for coverage during time gaps between jobs. He wanted insurance companies to sell policies across state lines, which would threaten the control states now exercise over companies that do business within their borders and lead to more abuses than already exist.

Lastly, McCain wanted to segregate sick people into a "pool" so that healthy people wouldn’t help pay the cost of medical services for people who actually need them. He ignored the fact that such a practice would raise the already high cost of coverage for people who can least afford to pay for it. As a spokesman for the conservative point of view, John McCain’s plan for health care "reform" was "business as usual."

Progressives have Governor Howard Dean, a medical doctor who’s been fighting for true health-care reform throughout his political career. In the video below, Dr. Dean explains why all Americans must be provided with real choices for affordable health care immediately.

Obama Health Care - (Republican View)

The president’s opening offer of healthcare at a teaser rate fails to deliver what we actually need, value, and can afford.

The release by the Obama administration of its initial budget “outline” reinforced its strong commitment to step on the health spending accelerator, notwithstanding some rhetorical cover suggesting purported cost savings within its roadmap for universal coverage. Any selective application of the budgetary brakes would only maneuver around some tight political corners, because the overall goal is to re-allocate any “savings” to spend more and more, with Washington in the driver’s seat.

To be sure, the impact of annual budget documents, as first submitted, tends to be exaggerated. The president’s budget primarily provides a political marker suggesting the policy paths for future action. Even when such budgets profess to lay out master plans for vast sums of public funds flowing out over the next ten years, their transitory shelf-life reminds one of Dallas Cowboys running back Duane Thomas’s description of his first Super Bowl in 1970: “if [it’s]the ultimate game, how come they’re playing it again next year?”

Once one blows away the political smoke, there remains little evidence in the budget of a serious commitment to deliver more substantial and lasting savings.In any case, President Obama’s preliminary budget framework would make the healthcare sector that some critics claim is already too “unaffordable” even more so.

The soft numbers presented in the budget amounted to $634 billion over ten years, tucked within a reserve fund that serves as a “down payment” for comprehensive health reform more likely to cost at least twice as much. This initial tranche of subprime financing at a teaser rate would come predominantly from the usual suspects—reimbursement cuts imposed on focus group–tested targets (drug companies and private insurers) and higher taxes on the $250,000-plus income club.

Once one blows away the political smoke, there remains little evidence in the budget of a serious commitment to deliver more substantial and lasting savings. Proposals for overhauling inefficiencies in the care delivery system, sensitizing the privately insured to value trade-offs, and reacquainting senior beneficiaries with the full costs of their Medicare entitlements remain either illusory, underdeveloped, or discarded in this initial Obama budget.

One should not be surprised. The healthcare portion of this budget is largely an extension of broader bait-and-switch tactics, for which the primary objective is to quickly lock in long-term structural changes in who controls healthcare choices. Left to less-urgent “out years” will be worries about how to renege on the too-generous terms of offers of universal coverage, comprehensive benefits, and lower list prices.

The short, postcard version of Obama’s health reform pitch to the public represents a faith-based initiative that straddles the line between audacity and mendacity: Insurance coverage for everyone; more choices that include keeping what you already have; choices that will cost less but offer better benefits because “someone else” will pay more; reductions only in waste; and new wellness interventions that will make us all healthier anyway.

Assuming that last year’s presidential campaign rhetoric tries to engage the reality of legislative enactment and administrative implementation, the president’s health plan will rely on five new tools and structures:

A national health insurance exchange would facilitate centralized regulation of insurance offers and purchase—purportedly to reduce administrative costs and provide a broader menu of choices, but ultimately to crowd out competitive variation and meaningful choice within private insurance.

The exchange would include a new public plan option, the favored choice within the exchange menu to serve as a halfway house to Medicaid-for-all coverage much further down a political road.

Additional expansion of public program insurance coverage would build on the loosening of income-based eligibility limits for Medicaid and the State Children’s Health Insurance Program (SCHIP) in the recent stimulus package and on the crippling of private plan options in Medicare.

Mandates to ensure health coverage would start with employers but eventually move to all individuals, at least until affordability and enforcement hurdles become too visible and insurmountable.

Launching of more aggressive comparative effectiveness research would provide pseudo-scientific cover for the ensuing budgetary need to restrict coverage and limit reimbursements for higher-cost benefits, treatments, and products.

The short version of Obama’s health reform pitch to the public represents a faith-based initiative that straddles the line between audacity and mendacity.Beyond this sketchy framework, the president appears to be ready to subcontract most of the operational details behind this plan to the Democratic leadership and committee chairmen on Capitol Hill.

However, the clock is ticking as this latest window for political opportunism will narrow after this year. Although fiscal price tags seemed to matter little just months ago, ongoing difficulties in stimulating a stagnant economy may soon overload our political willingness to double down on bets on change we cannot quite believe in. At that point, we might begin to re-open the health policy debate to consider what we actually need, what we value, what we can afford, and the limits of what we can do through politics as usual.



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