The heavy toll that the COVID-19 pandemic has taken on older Americans highlights the need to strengthen the nation’s safety net for those requiring long-term services and supports, according to a new report in the Milbank Quarterly.
The report proposes a system of universal coverage to support long-term care for all older Americans. But we’ve been down this road before — trying for decades to create a viable, cohesive long-term care system. What makes anyone think things will be different this time around? Continue reading
In a new How I Did It essay, Dylan Scott of Vox explains how he and colleagues Ezra Klein and Tara Golshan created their multi-part series “Everybody Covered“ about how four countries accomplished universal health care. They also look at the state of Maryland, which has an all-payer system that may be a model for cost-containment in the U.S. The package, which contains both a series of articles and several podcasts, was supported by the Commonwealth Fund.
The series looks at Taiwan’s single-payer plan (which is arguably underfunded and which is not so beloved by its physicians), Australia’s public-private combo (with significant economic-based disparities), a “supercharged” Obamacare in the Netherlands (where it works partly because the country is not politically divisive) and Britain’s National Health Service. As Scott noted – there are always tradeoffs. Continue reading
AP Medical Writer Carla K. Johnson takes a look at health care reform in Massachusetts and Tennessee and how the coverage plans in those states can inform Congress’ approach to a nationwide expansion of health coverage.
In Massachusetts, Johnson reports, folks adopted a coverage first, cost second approach, with the assumption that once universal coverage was in place, it would be easier to use that leverage to pare down costs.
The Tennessee method, on the other hand, was to provide a limited, cautious program at first with the understanding that it would be gradually expanded if possible.
In the Columbia Journalism Review, Trudy Lieberman, president of AHCJ’s board of directors, tries to pin down exactly where Montana Democrat Max Baucus, chairman of the Senate Finance Committee, stands on the inclusion of a publicly funded option in any proposed movement toward universal health coverage. Thanks to his powerful position, Baucus is the gatekeeper for any proposed plans and will have significant influence upon their direction.
At issue is the role of private insurance companies in any proposed universal system.
Baucus recently told Time’s Karen Tumulty that he considered a public option a bargaining chip to force insurance companies into other reforms, like dropping restrictions on preexisting conditions and selling policies to everyone, sick or well. In other words, the chip would move them toward “market reforms” that bring more people into the insurance fold.
In different circumstances, Lieberman found that Baucus said that while he thinks health care reform can be accomplished without a private component, he might agree with Howard Dean that real reform wouldn’t be possible without a public component to the plan.
Los Angeles Times columnist David Lazarus points out that while, in a letter to influential senators, insurance industry executives promise, in Lazarus’ words, that “they’ll treat all people fairly in return for a government requirement that everyone buy their product,” the companies have left a significant loophole that might allow them to continue charging sicker people more money.
The key words are “benefit design,” the practice by which people can choose different levels of coverage at different prices. In a benefit design scenario, the elderly and infirm will be more likely to choose the more expensive coverage ranges while the young and healthy will choose cheap bare-bones coverage.
“It’s a very potent way of segregating sick people from healthy people,” said Karen Pollitz, a research professor at Georgetown University’s Health Policy Institute. “It’s essentially a way of continuing to charge more based on people’s health.”