Thursday, September 13, 2012

Howard Dean on Health Care Reform 2

I have two items today for my write-up on Howard Dean's Prescription for Real Healthcare Reform.

1.  To be honest, the health care plan that Howard Dean prescribes for the entire country reminds me of Paul Ryan's plans for Medicare, which concern the elderly.  (And, by Ryan's plan, I mean the version that was described on ABC News on August 14, 2012.)  Howard Dean wants a system in which private health insurance companies would compete with a public option (which would be like Medicare), people would be free to select from a variety of options (or stay on their current plan), and people would receive subsidies based on need so they can purchase health insurance.  And Paul Ryan supports giving the elderly vouchers to purchase health insurance from government-approved private plans, while allowing them to choose traditional Medicare if they so desire.

The plans sound similar, but are they?  Howard Dean would probably say "no" and would argue that Ryan's plan is deficient because it puts on seniors a financial burden of paying for health care, greater than what seniors currently bear.  And Dean would probably have a point.  But it seems to me that both sides are inconsistent, at times.  During the health care debate, when the public option was on the table, Republicans were saying that the public option would be a terrible idea because private health insurance companies would not be able to compete successfully against it----they'd be run out of business.  And yet, Newt Gingrich, and now Paul Ryan, propose to have private health insurance companies compete with Medicare.

I still have questions about Ryan's plan, though.  Ryan's plan is designed to save Medicare and to make it solvent.  I am open to correction on this, but I think that Ryan hopes that more seniors will take their vouchers and enroll in private health insurance plans.  But what if most of them choose instead to stay in Medicare?  In that case, would Ryan's plan change anything, or simply land us back to where we were before?  But suppose that a sizeable number of seniors do choose to enroll in private plans.  Would Medicare then have enough money to help those who choose to stay in it?

2.  Howard Dean says that information should be provided to physicians about what are the most effective treatments, in terms of health and costs.  That way, they can make informed decisions.  Dean anticipates an argument that I have heard or read from conservatives when he states on page 54:

"To be sure, comparative effectiveness research cannot be applied too rigidly.  A small percentage of patients will respond to one drug better than to another, despite the similar chemistries."  In short, what is considered to be the most effective treatment----in terms of health and cost----may not work for everyone.  Consequently, for Dean, the decision should rest with the physician about what is best for the patient.

But I have a question: What would prevent physicians from choosing the costlier treatments because that would make them more money?  Perhaps Dean would respond that his plan promotes preventative care and rewards doctors who keep or make their patients healthy, and so doctors under his plan would do the right thing.

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