Saturday, September 12, 2009

Obama's Healthcare Speech

Some thoughts on the speech:

I think it's interesting that two of the proposals that Obama outlined--mandates and taxing employer-provided care--were signature issues on the campaign trail as well. Mandates were one of the few big policy differences between him and Clinton--and he was opposed to them. Then Obama put out many, nasty ads against McCain because he wanted to tax healthcare. It's true, as many people say, that Obama's focus on healthcare was a defining characteristic of his campaign, and attracted many voters. But his actual policy stances have turned a full-180. Bizarrely, no one seems to have noticed, but I suspect that this is one reason why the issue is proving so intractable.

And stop blaming Republicans. Democrats, just a couple of years ago, showed no willingness to go forward with Social Security reform, and that's going to cost all of us who are young hundreds of thousands of dollars. Opposition parties sometimes behave as if they're in opposition, deal. If you have a majority in both Houses, just pass a bill.

I also see that one of the ridiculed conservative ideas on healthcare would be to "turn Medicare into a privatized voucher program." But that would be amazing! That forces people to be more responsible about their spending, while still funding it for people who don't have it. Note that countries with universal private insurance mandates--like Switzerland or the Netherlands--give out exactly these types of subsidies for people who can't afford care.

Obama apparently wants to cut Medicare Advantage. See Marginal Revolution for a run-down of these plans; basically they are plans which allow seniors to purchase additional care. So while people under 65 would be forced to purchase healthcare; people over 65 would be limited in their ability to purchase healthcare.

Also check out this great interview with a hematologist criticizing the "Dartmouth" approach to healthcare, which is convinced that 30% of healthcare costs as the result of waste and fraud, and can be cut through technocratic means. The counterpoint is that areas of high Medicare spending spend a lot for a reason. Atul Gawande singled out McAllen, for instance, as an area of high Medicare spending. But it's also a poor area with many health problems and little private insurance; the system overbills Medicare to sustain itself, but overall it's not a high cost area. Other analysis suggests that higher health spending is, in fact, related to better outcomes.

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