>There seems to be a lack of proposals that provide a bridge from incrementalism (tho SCHIP is a pretty good-sized increment, I think) to full-blown nationalhealth insurance. Our resident health expert at EPI, now sadly departed for greener pastures, was always reluctant to plumb this territory. Oneis to go for state-level systems. There is a roject on this underway in MD. But what about something short of universal but much better than what wehave now? Have you some ideas in this vein?
>max
I think there is a reason your former colleague was reluctant to plumb this territory. It is really hard to imagine any incremetal step short of singe payer health at the state level that would not backfire very quickly. One point is that the insurance companies take a huge bite - at least 25 percent, perhaps a third. (Private insurance is not only a large cost; it is also a cause of costs in other. Heal insurance companies are like cockroaches; it is not only what they eat but what they spoil.) Excess drug company profits also account for a substantial share.
Reform would seem to involve one of three paths:
1) eliminate the insurance company role, and reduce drug company profts, 2) cover more people or provide better coverage, by increasing health spending - leaving insuraers with their cut. 3)Cover more people by providing less coverage, or provide better coverage by covering fewer people - the approach the Oregon Health Plan was founded on.
In short, no one has come up with an approach short of single payer that seems both an actual improvement, and at least potentially politically feasible.
As discouraging as progress has been on this front, I think single payer at the state level is our best shot right now.