>The fact is that if lefties attack every issue they can on broad proposals
>like
>Bradley's health care plan, they just play into the marginal incremental
>poll-driven politics promoted by Clinton. If large proposals for massive
>expansions of health care spending are going to be savaged by Right and Left,
>then the safest political spot will be in the status quo middle.
I don't support Bill Bradley or his health care plan. I do not critique health proposals in the knee-jerk manner suggested in this paragraph. I do think health proposals seeking to increase or universalize access to health care for those now left out are very good things. The problem with Bradley's plan are not that he wants to increase coverage (but just can't get enough gumption up to include everyone), the problem is that he proposes a highly inefficient manner to do it.
Bradley's plan to privatize Medicaid has three problems:
1) Private insurers have 2 to 6 times more administrative overhead than Medicaid (so proposal is socially inefficient). That means for any fixed amount of health care spending less is actually going to provider's or patients (it usually the patient). It is possible to increase spending
2) There will be costs for those covered by the current system--they will have to learn what options are available to them and see if their preferred way of care is still available. These costs are only temporary and may be small for some, but my point is that every political change has opportunity costs. Nathan's stated opinion that any positive change is preferred over nothing is not the issue. The issue is that Bill Bradley had hundreds of policies to choose from as a candidate and he chose a weak and expedient one--that says far more about the man than any bogus dichotomy between reform and more radical change. The fact that his proposal is better than any other major candidate in 2000 (and incidentally worse than any Democratic proposal in 1988 or 1992) suggests that not voting for any candidate may be the smart thing to do (without any apathy or anarchism).
3) There are dynamic implications to shifting people to private insurance with a spanking new government push. Private employers would drop coverage for low wage workers who get insurance now ("it's all the papers"). This means that many people above PL who have to pay under Bradley's system would pay more.
> > Seconldy private insurers cherry pick - they don't want people with chronic
> > illnesses. That is why we have MediCAl to begin with.
>
>Which is the point of everyone under the Bradley plan automatically being
>eligible for the Federal system of health care plans to avoid such
>cherry-picking.
You miss the point.
There is no incentive for any private plan "independent" people with disabilities or cover the routine expensive stuff for most chronic. That's why you have to get really broad coverage (not HMO's but they occasionally try) to get the special care you want or end up in a Medicaid funded program. Home and community based services for disabled are not covered by any plan in the Federal system. It is the sole province of Medicaid. Currently, money is allocated to states who apply for HCBS waivers. Bradley's plan does not address this in any detail but his promise to create systems "based on successful demonstration projects" gives me major "willies". There is nothing fundamentally wrong with HCBS block grant system now (it could always use more money and independent living centers). It can be expanded and different individual sites have a lot to learn to improve care but this is true in any system.
> > Bradley's plan is not "universal". Who are the 5% that Bradley's
> > plan leaves out?
> > Not worthy citizens or what?
>
>And 16% are not covered now. So an additional 11% of the population covered
>looks pretty good. Again, Bradley's plan is not heaven on earth but it's an
>improvement.
Actually you shouldn't toss around these numbers so lightly. The important point is that Bradley's plan is means-tested. There are a lot of problems with mean's tested programs even with sliding scales. All children under 200% poverty are eligible and all adults with incomes under 100% poverty get full coverage with sliding scales for the next 100% of PL in both categories. Now this is less generous than what's already existing in about a dozen states. People not covered are those uninsured who are not eligible for a voucher. The 5% figure undoubtedly assumes that everyone on the sliding scale choose coverage as well. Many will not ("look Eustice, little Eunice, we got us a $15 voucher to buy us some of that health insurance this month") and many more could lose coverage because private employers drop coverage.
Peace,
Jim
"Managed care is the current jargon for bottom line health care. I don't mean to sound like a Karl Marxist but it's all about money. . . . There are people who'd rather have a dollar in their pocket than to have you alive. . . . HMO's are a bet you don't get sick-- you know, too sick. Because as long as you don't get too sick, they'll make money. See how the word "care" is confusing here?"
-- Billy Golfus, *MOUTH*, September 1996.