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Thread: The One State Taking a Big Run at Health Reform

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by SouthernDemocrat View Post
    Yeah but it's not the doctors, it's everyone else. Hospital care by it's very mature is labor intensive.
    That is hairsplitting, since without the doctors the places would be forced to close.
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    Therefore all progress depends on the unreasonable man.” ― George Bernard Shaw, Man and Superman

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by Greenbeard View Post
    I don't agree with the title of this Politico article, but it's a decent look at what Washington went through recently in passing the first 'public option' and the implications of that process for looming national reform efforts. And it's timely, given that other states are following closely behind with their own variations of the public option concept (Colorado may be next: Colorado's new public option proposal) and a federal approach, whether conceptualized as a pre-cursor to or a substitute for something more expansive, likely to be on the agenda.

    As the co-sponsor of Washington's legislation in the state Senate notes late in the article, the biggest challenge was the backlash from health care providers in response to attempts at cost containment: "'The most contentious issue is going to be, how do you compensate the providers and the hospitals?"' Frockt says."

    The One State Taking a Big Run at Health Reform




    Interesting nod to the all-in statewide health care cost growth target Massachusetts has been tracking to for the past seven years.
    Indiana had a public option like program years ago. From what I read about it, it was a well-designed disaster.

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by Greenbeard View Post
    I don't agree with the title of this Politico article, but it's a decent look at what Washington went through recently in passing the first 'public option' and the implications of that process for looming national reform efforts. And it's timely, given that other states are following closely behind with their own variations of the public option concept (Colorado may be next: Colorado's new public option proposal) and a federal approach, whether conceptualized as a pre-cursor to or a substitute for something more expansive, likely to be on the agenda.

    As the co-sponsor of Washington's legislation in the state Senate notes late in the article, the biggest challenge was the backlash from health care providers in response to attempts at cost containment: "'The most contentious issue is going to be, how do you compensate the providers and the hospitals?"' Frockt says."

    The One State Taking a Big Run at Health Reform




    Interesting nod to the all-in statewide health care cost growth target Massachusetts has been tracking to for the past seven years.
    If states can do their own thing, why do we need a federal approach?

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by ttwtt78640 View Post
    It may also force some care providers to simply no longer accept patients with that "public option" brand of insurance. I see this with Medicare supplemental (PPO) plans now - a given care provider may accept 1/3 (or less) of those insurance plans available for sale in that region.
    In the case of Medicare Advantage it’s more likely a provider isn’t in network because the insurer is curating its network to land quality bonuses. But yes, the biggest challenge these public options will face is forming a provider network. That limits how far down the prices paid can be pushed, as it should. This concept is a sort of soft rate-setting and the rates chosen can’t get too unmoored from what’s actually possible. It’s an interesting experiment.

    Quote Originally Posted by Drawdown View Post
    Indiana had a public option like program years ago. From what I read about it, it was a well-designed disaster.
    Most things from years ago that are called “public options” were just limited Medicaid expansions. Those were not generally substitutes for commercial insurance, were aimed primarily at expanding coverage, and had little to do with changing the dynamics of insurance markets. Access was limited to the targeted population by eligibility criteria.

    The public option concept is aimed squarely at commercial marketplace dynamics, specifically to boost competition on premium and put downward pressure on the prices providers negotiate with insurers. Anybody can buy the public option (unlike say a Medicaid product), which means it has the potential to upend markets—particularly those that are concentrated on either the payer or provider side.

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by jonny5 View Post
    If states can do their own thing, why do we need a federal approach?
    Why not? If a local market is intensely concentrated on the insurer or health care provider side and if the state is not taking or cannot (e.g., due to capture) take action to promote competition, an external jolt may be needed to give people choice and get the market putting downward pressure on prices again.

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by ttwtt78640 View Post
    Before messing with matters of life and death - let's start by "negotiating" the cost of public colleges down to an affordable level. Next "negotiate" away the cap on the number of medical doctors and other medical care professionals "produced" annually by those public colleges. Those improvements in public facilities alone would produce more doctors and other medical care professionals able (willing?) to work for lower salaries.
    I would be fine with allowing people to bankrupt out college debt if they can't find a decent job and for the underwriters to be able to recover a portion of those costs from the colleges. That would get things under control real fast and would be more of a market based solution (which we should use whenever feasible).

    It will kill majors in liberal arts studies most likely, but that's fine there will be people who pursue it anyway to become professors.
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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by Greenbeard View Post

    Most things from years ago that are called “public options” were just limited Medicaid expansions. Those were not generally substitutes for commercial insurance, were aimed primarily at expanding coverage, and had little to do with changing the dynamics of insurance markets. Access was limited to the targeted population by eligibility criteria.

    The public option concept is aimed squarely at commercial marketplace dynamics, specifically to boost competition on premium and put downward pressure on the prices providers negotiate with insurers. Anybody can buy the public option (unlike say a Medicaid product), which means it has the potential to upend markets—particularly those that are concentrated on either the payer or provider side.
    Indiana has taken a few swings at this issue. The two problems always their undoing have been low reimbursement rates limiting providers and the unwillingness of the working poor to make their sliding-scale premium payments.

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by Greenbeard View Post
    Why not? If a local market is intensely concentrated on the insurer or health care provider side and if the state is not taking or cannot (e.g., due to capture) take action to promote competition, an external jolt may be needed to give people choice and get the market putting downward pressure on prices again.
    Because the states never agreed to let other states control such things. But more importanly, its inefficient. People are different, states are different. What you want or works in your state we dont want or doesnt work in my state.

    Why do you care how my state deals with healthcare in my state?

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by tacomancer View Post
    I would be fine with allowing people to bankrupt out college debt if they can't find a decent job and for the underwriters to be able to recover a portion of those costs from the colleges. That would get things under control real fast and would be more of a market based solution (which we should use whenever feasible).

    It will kill majors in liberal arts studies most likely, but that's fine there will be people who pursue it anyway to become professors.
    That seems workable for college graduates, but ignores other factors contributing to why the graduate can't (or won't) get (or keep) a better paying job. In many cases the cause for low wages after college attendance was simply that the "student" never graduated with a degree, yet that was likely not the fault of the college.
    “The reasonable man adapts himself to the world: the unreasonable one persists to adapt the world to himself.
    Therefore all progress depends on the unreasonable man.” ― George Bernard Shaw, Man and Superman

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    Re: The One State Taking a Big Run at Health Reform

    Quote Originally Posted by tacomancer View Post
    I would be fine with allowing people to bankrupt out college debt if they can't find a decent job and for the underwriters to be able to recover a portion of those costs from the colleges. That would get things under control real fast and would be more of a market based solution (which we should use whenever feasible).

    It will kill majors in liberal arts studies most likely, but that's fine there will be people who pursue it anyway to become professors.
    The underwriter for these cases (the ones that can't be discharged in bankruptcy) is the federal government. I think that's a fine idea.

    I would tend to ratchet it down from the other end though. If the students from college A are defaulting on $20,000 loans, then incoming students will have access to $10,000 loans.

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