Wednesday, November 16, 2005

Health insurance and democracy

While the devil is often in the details of a health care plan, Gov. Blagojevich's plan for Illinois kids sounds pretty sensible. The major flaw in existing assistance for health care is that there is a point at which low income assistance just stops cold. That means people who are rising out of poverty take a big financial hit or a have to risk their health when they cross the threshold. By having a sliding scale system for everyone, Governor Blagojevich will cover everyone at a cost that's reasonable for the family. Combine that with a law that treats health insurance like car insurance (everyone must be covered), and you've got universal coverage at a fair price.

The major critique that the Times piece quotes is that this plan may reflect the Governor's hope to get re-elected. Of course it does. That's a good thing. The possibility of re-election in a democracy is what drives politicians to do good things and to fight for good ideas. If the worst that can be said of this plan is that it'll be so popular that the Governor can ride it to re-election, I can't see why any Governor would not propose a similar system.

The article does have this confusing line:
The state costs, the aides said, will be paid for by shifting the management of 1.7 million Medicaid recipients. Those patients will no longer go to any doctor on a list of eligible doctors, but to a single physician who will work on more problems earlier, saving an estimated $56 million the first year.

Does this mean that each patient would be assigned a doctor, or that they'd have to pick a family doctor and stick with her, or that there's one doctor that every patient will go through? Logic rules out the latter, but the loss of doctor choice could be unfortunate, depending how it's implemented. And why should restricting doctor choice reduce costs?

And what's that bit about "work[ing] on more problems earlier"? Are we just talking better preventive care, which would mean fewer, shorter visits? Because that might be great for adults, but most kids' visits to doctors are for illnesses, and you treat those when they happen.

The other possibility is that the plan is to reduce the use fo ERs for primary care, which would dramatically cut health care costs. Right now, an ER can't turn away a patient with a serious enough problem, so people without insurance wind up having to use ERs for problems that could be more cheaply handled at a doctor's office. If the plan is to make that happen, kudos again.