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I made this flowchart to drive two points home:
- A tremendous amount of the shouting has tried to convince people that this is "too complicated" and so we should throw up our hands and give up. But for most Americans, figuring out "what does health insurance reform mean for me" requires answer three questions -- "do I currently have government-provided health care?", "do I currently have employer-provided health insurance?", and "how much money does my family earn". That's it! Three questions! That's easier than ordering dinner at T.G.I.Friday's ("What would you like to drink?" "What would you like to eat?" "How would you like it cooked?" "Would you like fries, chips, cole slaw, or a side salad?" See! Four questions!). So the next time Betsy McCaughey shows up with a one-thousand page binder, remember that nine hundred ninety-nine of those pages happen behind the scenes. People who are not employed by health care providers or insurance companies only have to worry about one page.
- The other point I wanted to drive home is that the Public Option will only affect a small number of people. It's not even available if you have employer-provided insurance. Making regulations 10% more consumer-friendly for 177 million with employer-provided insurance has more overall impact than doubling the size of Public Option enrollment from 12 million to 24 million. Lord knows I would like to see the public option, but other parts of insurance reform will have equal if not greater impact.
Finally, i the interests of balance, here is a Republican flowchart from their budget proposal submitted earlier in 2009:
6 comments:
The first point is that there is the problem of political legitimacy. Mandatory entry into a Captive Market without a publicly administered choice is the functional equivalent of Taxation without Representation ... you have neither a choice to opt out nor a say in the running of the system.
The second is that you are assuming a static outcome, rather than a dynamic one. If we establish an individual mandate with government subsidized health insurance premiums restricted to for-profit corporations, those corporations have a strong incentive to get all the people qualifying for the subsidy into the system.
So we are establishing a system where there is a strong mutual self-interest of insurance companies to ramp up the numbers of people who receive the government subsidy to use to choose between available premiums, as well as the strong mutual self-interest in undermining the regulation of policies in those markets.
Provide a publicly administered choice in the exchanges, and the elasticity of demand for corporate health insurance as a whole rises dramatically, and while the interest in gaining increased subsidies remains, the commercial benefit of undermining regulation in the markets is substantially reduced, because policies perceived as junky policies will not sell as well when there is the alternative of a not-as-junky policy seen to be available.
The health insurance companies know this ... that is why they are investing so much in demonizing public choice in the markets that will cover so few, and investing so little in fighting regulatory reforms. Given the right market structures, the experience of the last thirty years is that regulations can be undermined and eventually eliminated over time.
It's not even available if you have employer-provided insurance.
Does it matter to the chart that small businesses (10 and fewer employees then 25 and fewer employees) are allowed into the exchange?
Nice flowchart! One suggestion:
People scan instead of reading, and when I look at "Employer provided Insurance: yes--->" the first thing I see is scary, bolded words like "Ban, Ban, Cap, Require", so my immediate reaction is not positive.
Instead of explaining what the government is going to do to the insurance companies, you could try rewriting it in terms of how it benefits me. For example:
- Your pre-existing conditions will now be covered
- Your benefits won't have lifetime caps
- Your annual out-of-pocket expenses will be capped
- The insurance company won't be able to cancel your insurance if you get sick (a practice called rescission)
- Men and women will pay the same rates
- Preventive care will be free
- Adult children can stay on their parents' plan
- You decide to when to cancel your insurance plan, not the insurance company
Also it's not clear what the bold labels under the bubbles mean. 64 million what?
I think your chart is a great way to show what's going on with respect to insurance according to the number of people served. My guess is that the next series of objections to "the plan" will be around how it is financed, so a chart that enables us to follow the money wold be a great addition.
"Does it matter to the chart that small businesses (10 and fewer employees then 25 and fewer employees) are allowed into the exchange?"
I can't tell from the Kaiser study whether or not "employer-sponsored" is just large employers or it includes small employers. But in general it turns out even most small employers that currently offer insurance are likely to keep it ... it's a good way to attract employees, etc.
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