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Thursday, June 11, 2009

Senator Gregg Offers Counter-Proposal for Health Care

I should be nervous about a competing health care reform plan proposed by a Republican Senator, especially one who has already pulled one switcheroo on the Obama Administration. But at first glance, I like some of the things I hear in Senator Judd Gregg's CPR—Coverage, Prevention, Reform—plan. Among the possible positives: "paying for quality, not quantity":

According to a study at the Dartmouth Institute for Health Policy and Clinical Practice, as much as $750 billion is spent each year on procedures or health-related services that don’t necessarily help patients get better. For example, when discharging patients, hospitals have an obligation to provide patients with a care plan to ensure they don’t end up readmitted. However, Medicare pays more to hospitals when a patient ends up back in the hospital. And physicians are paid more when they order more tests, procedures and office visits, whether you need them or not.

Ask yourself: Would you pay your dinner bill if the waiter spilled your first plate all over the floor, brought you a replacement plate, and then charged you double? [Senator Judd Gregg (R-NH), "Health Reform Possible Without Growing Government," op-ed, Yahoo News, 2009.06.11]

Senator Gregg would challenge doctors to get the job done right the first time with performance incentives. He would also publish data that would let you compare the doctors in your area.

Senator Gregg still resists any public plan that would compete with the private insurers. According to a summary on his website, CPR would require all of us to buy insurance and require insurers to cover all of us—i.e., no more exclusions for pre-existing conditions. It offers subsidies for premia and deductibles (that's interesting!) for folks making up to three times the poverty line (I think that's us). No word on whether those subsidies would inflate insurance rates the way some say financial aid inflates college tuition.

Other things in Gregg's proposal that are worth talking about:
  1. capping the tax exclusion for employer-based coverage at $5K for individual plans and $11.5K for family coverage—in other words, taxing benefits above those amounts.
  2. allowing tax deductions for health insurance purchased on the individual market (wait a minute—I thought we already got to do that. Clarification, anyone?)
  3. first-dollar coverage for preventive care (screenings, shots, etc.)
I'm still backing the single-payer option over the insurance-purchase mandate, which I can't help believing will be more inflationary. But I give Senator Gregg credit for being the rare republican this year who can stop saying "No!" long enough to compose a rational plan.

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