Meet the New Health Care Vision (Same as the Old Health Care Vision)

Like anyone borderline obsessed with the policy of universal health care, when I saw the headline in the Boston Globe trumpeting "New U.S. health insurance program envisioned", the pulse started a-quickening.  I was even more excited when I saw it was from the renowned research group The Commonwealth Fund, whose health care policy study of the U.S. compared to other nations is regularly cited by, well, everyone.  So I dove into the executive summary only to learn that this new vision of health care is... well... basically the same as everyone else's vision of health care.

The caveat is I have not yet read the full 122 page report, only the executive summary, but I nearly began mumbling along with the features of this "bold new vision."  A health insurance exchange where everyone (particularly the uninsured) could select from a menu of comprehensive options - check.  A public plan modeled on Medicare as one of those options - check.  Subsidies if you can't afford the premiums - check.  Individual mandate for everyone to get coverage - check.  Minimum benefit standard - check.  Expand Medicaid, Medicare and SCHIP eligibility - check.  Reform private insurance with guaranteed issue (no pre-existing conditions), community rating (everybody's got the same price) and guaranteed renewal of coverage (no canceling the policy when the customer comes down with cancer) - check.  I've just outlined the coverage part of their proposal.  I've also described the Jacob Hacker public competitor, the John Edwards plan, the Hillary Clinton plan, the Barack Obama plan (minus the mandate), the Max Baucus plan, and the plan Tom Daschle suggests in his book (plus the Federal Health Board).  As Ecclesiastes says, ain't nothing new under the sun.

The Commonwealth Fund similarly stresses aggressive reform for cost and quality, but it's the usual suspects again.  Health IT to cut costs and measure quality.  A Center for Comparative Effectiveness and Health Care Decision-Making for independent comparative effectiveness research.  Increased money for primary care, prevention and chronic disease management.  Reforming compensation for episodes of care, coordinated care, the medical home, and more transparency in payment.  Again, I've seen this movie before... in fact, it feels a little like Groundhog Day.

Although far from novel, I'm still looking forward to reading the whole proposal.  For one thing, the Commonwealth Fund is far more specific on the statistical modeling and cost benefit analysis of their various programs than any politician has been to date.  Jacob Hacker has been making an argument that the public competitor is not just a good idea (and a way to move down the road to eventual single-payer) but an economic necessity to prompt the insurance company to reform their practices - but the exact economic pressure points are far more explicit in this report.  They also spell out how crucial the compensation reforms are to cutting costs - a point often glossed over.  Secondly, the Commonwealth Fund is up front with a projection that the plan will have difficulty getting to absolute zero - that providing coverage to 40 million Americans is doable in year one and the remainder can be whittled down, but might still leave some quantity behind.  This candor is refreshing - we know from other government programs that getting the last few stragglers into any program is excruciatingly difficult.

But if there is news in this report, it's that the Commonwealth Fund now joins the choir of progressive voices embracing the model which will likely be the basis of this year's legislation.  That may not be good news for ardent HR 676 supporters, but it's another voice of authority for the public to be persuaded by.

Update: Something I missed before -- instead of subsidies to afford premiums, premiums for the public plan and plans offered through the exchange would be capped at a percentage of income, somewhere between 5 and 10%.  That's a different approach (albeit presumably it works out to have the same effect).  Mea culpa.