The Gathering Storm

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The Gathering Storm

• The Economy Is Weak
• State Budgets are a Disaster
• Federal Deficits are Back to Stay
• Health Spending is Soaring

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Actual
Structural (controls for booms, recessions)
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Unrealistic or Wrongheaded Visions

• Medicare for All
• Single-Payer Run by States
• Employer Mandates
• Individual Tax Credits Alone

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Realistic Division of Responsibilities

• Federal Money Tax Credits and Grants
• State Operations Insurance Systems, Pools and
  Backstops
• Employment Focus Enrollment, Outreach
  Bookkeeping
• Federal Performance Tracking
• Individual Mandates

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Transitional to Universal?

• Step 1. (Enacted but not implemented) COBRA/Tax
  Credit system for workers displaced by trade
• Step 2. Expand to all displaced workers
• Step 3. Clarify how credit follows workers to
  new job if no employer health insurance or
  waiting period
• Step 4. Allow credit to follow LOW-WAGE workers
  indefinitely

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Medicare Reform

• Low Income
• Zero-Premium Catastrophic
• New Supplemental and Comprehensive Plans
• Compstat Performance Basis

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House Medicare Bill

• 500 in Spending ? -200 in Net Benefit
• 1000 in Spending ? 200 in Net Benefit
• 4,8000 in Spending ? 700 Net Benefit
• This is not good, especially if it disrupts
  Employer-based Retiree coverage

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What About Costs?

• Anti-Trust Enforcement (Especially Hospital)
• Thoughtful Hatch-Waxman Update
• Quality, Liability, Disclosure
• Disease Management and Chronic Care
• Consumer Empowerment, Comparative Information,
  Choice

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What About Revenues?

Unsubsidized Health Insurance Doesnt Work