Some 2020 homework
So with the midterms now in the rearview mirror, the folks at
Health Affairs are getting us ready for 2020.
If you've got health care wonkery tendencies, both are well worth your time, maybe after you are done digesting turkey on Thursday. Alas, they are behind the journal's paywall, so here's a taste:
Glied and Lambrew note that the various flavors of public options and/or Medicare expansion may be politically attractive but "technically and operationally difficult." Medicare for All, the full-fledged version, would reduce the role of profits in health care and reduce administrative expenses (an applause line for Democrats). But Glied and Lambrew say "the line item for this single new health program would constitute at last half of all federal expenditures." That might give many Americans pause.
Senior Contributing Editor Timothy Kelley took a look at
Medicare for All and Medicare expansion
in our October issue and made the point that Medicare for All might be just too much change.
Chen goes over the state innovation approach that was given its fullest legislative expression in the Graham-Cassidy-Heller-Johnson legislation considered by the Senate in 2017. The goal of turning health reform care over to the states and paying for it with block grants is to lower costs, expand coverage options, and give state leaders flexibility to make choices that will work at state level, Chen writes. He also sees the federalist approach to health care reform as a way to bridge (you might say fuzz over) some strong disagreements among conservatives about health care reform and coverage.
And what about pre-existing conditions? In Chen's view, the laboratories of democracy will need to steer clear of tinkering with the ACA's prohibitions on exclusions because of their abiding political popularity.