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Tuesday, March 28, 2017

Paul Krugman: How to Build on Obamacare [feedly]

jcase: So, PK is ready to resurrect the "public option", but no mention of Medicare for All. Too Bernie, no doubt. Unfortunately the insurance industry views the "public option" with the same hatred as Medicare for All. Both put them out of the health insurance biz in the end. They might even do better with Medicare for All as contractors to provide or supplement administrative services in the vast public system which Medicare For All, and a "public option" will require.  The private insurance industry's BASE is their customers. Customers pay premiums and file claims. Customers with paid claims are happy and tend toward loyalty to the company that paid them. They got what they paid for. On the other hand customers with unpaid, or partially paid, claims may not be happy. 

The public option will likely be the cheapest for comparable coverage. Under any configuration, controlling costs mandates universal coverage, both healthy and sick people. Since coverage MUST be mandatory -- it would seem politically impossible for a public option coverage to be any worse than Medicare or expanded Medicaid. Coverage under both those plans beats anything currently for sale at an affordable price. Regardless its hard to see how insurance companies thrive in that environment, except insofar as they provide a necessary administrative service to 170 million people. 

Unfortunately providing 170 million health care customers with a vital service is also grounds for a potentially vast political resource to exploit. In addition Republicans are not likely to bring either, or anything, into being.

Both will require an anti-Trump,anti-austerity, anti-Stupid upheaval --- an upheaval that, if it can find coherent form, will be able to do either -- time to keep Medicare for All on the table. "Why take the long way around Kelly's barn?", as they say in Vermont. "The front gate is wide open."  Ooops...sorry PK...too Bernie, again :)

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Paul Krugman: How to Build on Obamacare
http://economistsview.typepad.com/economistsview/2017/03/paul-krugman-how-to-build-on-obamacare.html

"If Mr. Trump really wanted to honor his campaign promises about improving health coverage..., there's a lot he could do":

How to Build on Obamacare, by Paul Krugman, NY Times: "Nobody knew that health care could be so complicated." So declared Donald Trump three weeks before wimping out on his promise to repeal Obamacare. ...
Actually, though, health care isn't all that complicated. Basically, you need to induce people who don't currently need medical treatment to pay the bills for those who do, with the promise that the favor will be returned if necessary.
Unfortunately, Republicans have spent eight years angrily denying that simple proposition. ... But put politics aside..., what could be done to make health care work better...?
The Affordable Care Act deals with the fundamental issue of health care provision in two ways. More than half of the gains in coverage have come from expanding Medicaid... And that part of the program is working fine, except in Republican-controlled states that won't let the federal government aid their residents.
But Medicaid only covers the lowest-income families. Above that level, the A.C.A. relies on private insurance companies, using a combination of regulations and subsidies to keep policies affordable. This has worked well in some places. ...
Overall, however, too few healthy people have purchased insurance, despite the penalty for failing to sign up... As a result, some companies have pulled out of the market. And this has left some areas, especially rural counties in small states, with few or no insurers.
No, it's not a "death spiral"... But the system could and should be improved. ...
What about the problem of inadequate insurance industry competition? ... At the very least, there ought to be public plans available in areas no private insurer wants to serve. There are other more technical things we should do too...
So if Mr. Trump really wanted to honor his campaign promises about improving health coverage..., there's a lot he could do... And he would get plenty of cooperation from Democrats along the way.
Needless to say, I don't expect to see that happen. ...
And the tweeter-in-chief's initial reaction to health care humiliation was, predictably, vindictive. He blamed Democrats, whom he never consulted, for Trumpcare's political failure, predicted that "ObamaCare will explode," and that when it does Democrats will "own it." Since his own administration is responsible for administering the law, that sounds a lot like a promise to sabotage Americans' health care and blame other people for the disaster.
The point, however, is that building on Obamacare wouldn't be hard, and wouldn't even be all that complicated.

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