The health care reform debate has been going on for so long here in California folks seem to have adopted a short-hand for referring to the issues. “Affordability” carriers a lot of weight for just six syllables. “Individual Responsibility” is another phrase with a heavy load. The danger is that this negotiation fatigue boxes out other issues. So here’s three questions I wish folks were asking:
- Why is there no outcry concerning the one million Californians who are eligible for, but fail to enroll in, Healthy Families and Medi-Cal?
You’d think this would be everyone’s number one priority. First, because it’s the right thing to do. Second, reducing this number would demonstrate the state’s ability to deliver on it’s earlier health care reform promises. Third, it’s an easy win as the one million Forgotten represent about 15 percent of the state’s uninsured. CAHU has focused on this situation in its Healthy Solutions reform plan, but no one else seems to mention it. Why isn’t the Legislature holding someone accountable? Why isn’t the Governor calling someone on the carpet? This, of course, assumes someone is responsible. But if so, whatever they’re doing now isn’t working well enough. It’s time to try something new. Healthy Solutions contains a laundry list of ideas. Others no doubt have even better ones. The answer: hold one person accountable, give this person the authority, flexibility and resources to make something happen and a deadline by which it needs to happen. If they can’t deliver, find someone who can.
- Why does everyone assume there has to be just one minimum plan?
At the Assembly Health Committee hearing on October 31st, there was a great deal of discussion about the minimum benefit package. And there should be. If individuals are required to have coverage, it’s useful to know what that coverage might be. Yet the underlying assumption of those questions was that there’d be just one minimum plan. But why? People have different needs. For some, a high deductible plan is a good deal; for others it means access to health care remains out-of-reach. Healthy Solutions recommends three minimum plans (in addition to Healthy Families and Medi-Cal): any HSA-eligible plan; a high deductible catastrophic plan; and a core plan with lots of first dollar benefits, but lower annual and lifetime caps (CAHU borrowed the attributes for the Core plan from a package currently available to farm workers). There are no doubt other acceptable minimum benefit plan designs out there. So why limit the debate to coming up with just one? The answer: put some actuaries in a room and don’t let them out until they produce three or four roughly equivalent plans designs that address the needs of a diverse population. Then let the policy wonks play with them. But at the very least negotiators need to acknowledge the need for more than one minimum plan.
- Why are business problems evidence of the failure of the private sector, but the shenanigans of public officials doesn’t seem to worry anyone?
There are those who hold up the mistakes, crimes and foolishness of some corporate players as conclusive evidence that the private sector is incapable of delivering a fair health care system. Yet there are plenty of examples of government agencies and public officials who are also guilty of mistakes, crimes and foolishness (I can name names if that’s necessary, but I’m sure you can, too). Shouldn’t this be conclusive evidence for these same folks that the public sector is incapable of delivering a fair health care system? The answer: There isn’t one, really. People need to recognize that we’re dealing with human institutions here, perhaps a little less stone throwing would be a wiser approach to the debate. Unfortunately, all sides seem to take comfort in the rockier side of the debate.
These are three of my questions I wish would be more widely considered. What are yours?