The Issue of Healthcare Reform, Brought to You by the Commenters of Anchor Rising

There's a good debate about healthcare going on in the comments section on last night's gubernatorial debate that's worth promoting into its own post...

"Brad Fric" begins by defending the current RiteCare Program...

Not for nothin', but RiteCare is a good value. low admin. fed match.

Would it be better to increase the number of uninsured, kicking kids into ERs? Taxpayers and commercial rate payers foot that bill - to make it worse, ERs (uninsured care) are less efficient than RIte Care, which has primary care and prevention.

Other areas of medicaid have not won accolades as RIteCare has. if you want to criticize medicaid, take a look at the programs that are running less efficiently.

"John" responds by agreeing that the overuse of ERs and the other issues that Brad raised are real concerns, but that many other factors are also in play. "John" suggests some coverage schemes tried in other places that we should try to learn from...

Brad raises some good points. But there are others that are needed to complete the picture. Clearly, a national single payer health insurance system with competing private and non-profit service suppliers can efficiently deliver very good health care outcomes. Just look at Australia -- better health care outcomes at a lower share of GDP spending than the US on health care. But there's a catch. The taxpayer financed Australian system covers only basic heatlh care needs (and it has income scaled copays to limit overusage of it). Certain health care treatments are deemed luxury goods, and have to be paid for separately if you want them (hence Australia's thriving private health insurance companies). The analogy is to education -- taxpayers pay for K-12 for everyone, but college is, effectively, a luxury good.

To bring this back to the US, the most infamous blow up of a state Medicaid system was TennCare. Like RiteCare, it didn't offer an Australian style minimum coverage system; rather, it offered a package that was superior to most offered by private health insurance companies. Moreover, thanks to the litigation efforts of Tennessee's advocates, its coverage was constantly expanded, and copays blocked. Unsurprisingly, it attracted a lot of people and blew up the state's budget. As a result, TennCare was sharply cut back.

The comparison to RI is quite clear. RiteCare coverage is actually superior to individual policies you can buy from BlueCross -- a major reasons why some of RI's advocates have been looking for ways to allow people to stay on RiteCare rather than shift to RiteShare, in which the state helps pay for a portion of a low income worker's coverage via a company group health policy.

In RI you can also see the numbers of people on RiteCare growing, and little downward movement in their utilization rates for key services. Finally, despite the presence of our RiteCare program, RI also has the nation's highest taxpayer financed spending on uncompensated care per uninsured resident. This should come as no surprise to anyone. When you offer the nation's most generous welfare programs, and let people stay on them longer than anyplace else, you get rising demand for them. Even this might be sustainable if RI had one of the nation's most vibrant economies and was generating substantial amounts of tax revenue. But this isn't the case. When you combine high spending on state financed healthcare with high spending on a whole host of other inefficiently run programs, the result is high tax rates, poor services and a declining economy. And this is only compounded when you are becoming a bedroom community for people who commute to jobs (and pay most of their income taxes) out of state.

In theory and in practice (e.g., in Australia) a well designed national single payer health insurance program should be the solution to a lot of the healthcare problems facing the US today. RiteCare (like TennCare) could have been a model for the nation. Instead, thanks to the efforts of our advocates and their allies in the unions and the General Assembly, it has become just another part of the process that is bankrupting Rhode Island.

("Klaus", are you paying attention to all of these "real world" examples being cited?)

Finally, "Tom W" expresses skepticism that an Austrialian-type single payer program can be successfully implemented given the current political culture...

John's comments above regarding the Australian system are well put.

The problem is, in this country, it would be the proverbial "camel's nose under the tent."
On the national and state level the "Poverty Institute" ilk will never be satisfied with a system in which basic / emergency health care needs are met by the public sector, but others (who invariably will be mischaracterized as "the rich") can "afford" "better" healthcare. It just isn't fair, you see.

They won't be satisfied until everyone is trapped into a low-quality, and expensive, 100% public-sector system (e.g., HillaryCare).

It's no mere coincidence that medical inflation didn't start to take off until after Medicare / Medicaid started kicking in. Already in de facto control of about 50% of the total healthcare market, the government has already screwed it up.

Just thinking about putting the same type unionized slackers who run the Registry of Motor Vehicles in control of healthcare is enough to make one ... ill.

Healthcare reform is certainly going to be a major public policy and political issue in the coming year or two. Let's see if we can find some points we agree on, before the two sides start tearing each other apart in the electioneering phase of the 2008 political cycle.