Making a Good Health Care Plan Great For Maine
Steve Benen linked over the weekend to a Bangor Daily News account of an Olympia Snowe health care forum in which the Senator sounded very open to potentially far-reaching reforms:
“We have a totally dysfunctional system now,” she said. While like most Republicans she would prefer to see the private sector collaborate on an effective change, a government-run health care system may be the only way to get the job done, she said.
Ezra Klein observes that Snowe is a little bit lacking in the coherence department:
Snowe’s position is a bit of an odd one: She holds that we may require a single-payer system but probably should have a public insurance option. The next step, she says, is to fix the market. And Snowe argues that it’s not clear that you can do that with a public insurance option. She’s raised the possibility that the public plan is actually too easy on private insurers. It’s a government plan, she says, and every lobby and advocacy group will exert pressure for it to cover every ill, ailment, and treatment. As such, the plan will quickly prove a better deal for the sick than the well, and it will end up being the equivalent of a “bad bank” for health risks. The private insurance market will simply skim off the healthy. In other words, the public plan wouldn’t compete with the private market so much as subtly subsidize it.
I would say that the main thing in this sort of situation is to stop thinking about the big issues, and start thinking about little ones. How can you structure a health care program so as to be very beneficial to the state of Maine? It’s not genuinely the case that inadequate levels of subsidies to sparsely populated rural states are an important failing of the current American health care system. But with the two “most likely to swing” Republicans coming from Maine, the Chairman of the Senate Finance Committee coming from Montana, and the head of the Senate Budget Committee coming from North Dakota this is probably the shortest route between the status quo and major reform. The major question becomes whether or not significant, broad changes like a meaningful public option can be structured in such a way as to be appealing to these constituencies. Maine’s a weird state, maybe it needs blueberry subsidies or provisions that take into account the special needs of states with large seasonal swings in population.
20 Responses to “Making a Good Health Care Plan Great For Maine”
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April 13th, 2009 at 11:50 am
If I were pushing a public health plan, I would announce some model programs for underserved rural areas. Small towns really are someplace where having a government-employee full-time doctor on hand would make sense. One of the things that has happened in Massachusetts is that everyone having health insurance means that the rural areas are discovering how underserved they really are. There were people needing doctors before, they just couldn’t afford them.
April 13th, 2009 at 12:02 pm
Anyone in ME who doesn’t have insurance through their work has only one option; Anthem Blue Cross. Nobody else will sell insurance in ME, the free-market system has failed, and Snow knows this.
The state tried a program, Dirigo, but they only offered it to small businesses at first, businesses unable to afford insuring employees. So she also sees that the private sector insuring employees isn’t the real solution. And when you open it up to private people, the cost skyrockets because so many of the uninsured/underinsured have chronic problems or problems they’ve put off dealing with because of a lack of insurance. There’s not enough healthy population to distribute the cost amongst for fair premiums.
April 13th, 2009 at 12:17 pm
Maine, like WV, has an aging population that is underserved because of the continuing drain of primary care out of medicine. Doctors are retiring and are not being replaced by new doctors, and the problems faced by older people are actually much more complex than they were a generation ago. This leads to increased use of hospitals as people hit health care providers at a much more acute stage of illness. Reform of medical education and primary care payment would be especially good for these states. Focusing a program on repopulating general practitioners and general surgeons in these places would be very good, as would subsidies for rural hospitals to be linked to more specialized facilities through electronic records, telemedicine, etc. If we get a public plan (”Medicare for all!”) out of that mix, I would consider it money even better spent.
April 13th, 2009 at 12:46 pm
Focusing a program on repopulating general practitioners and general surgeons in these places would be very good
B-b-but surely the market will determine whether rural Maine should have GPs and surgeons?
This is actually the kind of situation where there’s a federal interest in providing incentives for med students (or qualified doctors) to go into general practice in rural areas or inner-cities.
April 13th, 2009 at 12:50 pm
The national GOP needs to rein Olympia Snow in. This is getting ludicrous. She needs to shut up and vote the party line. I do hope she gets a stern rebuke somewhere.
On another note, public-option, so to speak, is a bit of a bad joke. The accounting method required of the government program is different from the one required of private insurers, and consequently the public program is not required to account for full costs, as private insurers are. This creates a perverse incentive to, when the Democrats are in control of Congress, to ideologically stack the market with below-cost premiums and overwhelm private competitors, unless when the Day of Reckoning comes there are no private insurers left, and the federal gov’t is left with a giant deficit hole to plug.
April 13th, 2009 at 12:52 pm
Until such time as the Democrats fix the public-option accounting, it remains a disgusting, vile partisan maneuver and nothing more.
April 13th, 2009 at 12:58 pm
And another thing; public healthcare is almost certainly subsidised by private subscribers. Right now, hospitals face something like a 40% cost shortfall whenever they take in patients under Medicare. Simply put, the government plan never pays up to full cost of the serviced rendered, and that 40$ is subsidised by private insurers.
That’s part of the reason why insurance premiums are so high.
April 13th, 2009 at 1:26 pm
It’s not genuinely the case that inadequate levels of subsidies to sparsely populated rural states are an important failing of the current American health care system.
Uh, no. They used to have hospitals in every county in West Texas (and similarly in rural areas in other states), but once the HMO/cost-cutting measures kicked in the late 80’s and early 90’s, they closed a bunch of those hospitals down. Thus, someone, somewhere was laughing that Texas had 254 counties (each averaging about 2/3rds the size of Rhode Island in size) and 80 county hospitals. So, they used to have more, but they cut all those out. So, if you get injured in rural area, drives of 40-50 (or more) miles to get to a hospital are not uncommon.
I expect Maine isn’t too different.
max
['Long way to go when you're bleeding out.']
April 13th, 2009 at 1:26 pm
She needs to shut up and vote the party line. I do hope she gets a stern rebuke somewhere.
I’m sure this highly popular moderate is shaking in her boots.
April 13th, 2009 at 1:43 pm
@ Myles SG:
This isn’t Westminster, you Tory prick. American legislators have a tradition of relative independence compared with the UK (though less so during the Bush Congresses). Olympia Snowe should vote however her conscience tells her. Screw party-lines and party-liners.
April 13th, 2009 at 2:08 pm
The national GOP needs to rein Olympia Snow in. This is getting ludicrous. She needs to shut up and vote the party line.
This would, of course, lead to her defeat at the next opportunity, since she serves a highly blue state that only elects her because of her “moderation”. It’s the same reason Nelson and Landrieu don’t vote the party line. I’d think you would understand how American politics works.
April 13th, 2009 at 2:13 pm
Unlike Myles, Snowe, at least, is smart enough to realize that this is probably the point in her career where she will hold maximum political power, just as Lieberman was smart enough to realize that 2006-2008 was the high water mark of his own power. We haven’t heard much from Joe lately, have we?
April 13th, 2009 at 2:35 pm
I really think we need to rebuild lobster populations by captive breeding (protecting baby lobsters until they are medium large). It will be costly and very labor intensive, but I think it would be worth it.
Oh and what about the border with Canada ? There is strong support for allowing re-importation of pharmaceuticals, but we don’t want large re-importation corporations. I think only people who live withing walking distance of Canada should be allowed to re-import and re-re-sell pharmaceuticals from Canada. If Voinovich wants a lake Eirie exception, he better get on board quick.
April 13th, 2009 at 2:49 pm
Olympia Snowe should vote however her conscience tells her. Screw party-lines and party-liners.
You are quite correct regarding the party mechanics. The curious thing is, I don’t observe similar praise when Evan Bayh chooses to do the same.
April 13th, 2009 at 3:01 pm
The curious thing is, I don’t observe similar praise when Evan Bayh chooses to do the same.
Why would it be “curious” that commenters on a liberal blog oppose party disloyalty likely to hurt progressive causes?
April 13th, 2009 at 3:45 pm
Then, Jasper, you ought not express such moral indignation regarding my wish that Snowe be put in her place.
What’s curious is that you can simultaneously oppose party disloyalty like Bayh’s and also say things like
As I have said before, liberals are self-righteous prigs with Messiah complexes.
April 13th, 2009 at 6:04 pm
Then, Jasper, you ought not express such moral indignation regarding my wish that Snowe be put in her place.
I haven’t. You ought to pay more attention to what you’re doing.
April 14th, 2009 at 5:04 am
Then, Jasper, you ought not express such moral indignation regarding my wish that Snowe be put in her place.
I haven’t. You ought to pay more attention to what you’re doing.
Sorry… forgot to say great post – can’t wait to read your next one!