Thursday, July 26, 2007

It's All Local

Days Until Bush Leaves Office = 543

Its been said that all politics are local. Judging by this clip up on the Washington Post's website today, this is particularly true if you eat at the diner down the street from my house.


Dodd Rolls Out Health Care Plan, Looks to Private Sector for Universal Coverage

Days Until Bush Leaves Office = 543

Senator and presidential candidate Chris Dodd rolled out his health care proposal today at a "kitchen table" campaign stop in Marion, Iowa.

Details of the plan, as released by the Dodd campaign, are:

  • Universal HealthMart. The Dodd plan will create a health insurance marketplace called the Universal HealthMart that is based on, and parallel to, the Federal Employees Health Benefits Plan (FEHBP). Individuals and businesses will pay for coverage within Universal HealthMart based on their ability to pay. If a person or business is unable to pay for insurance, the government will subsidize their premium share on a sliding scale based on income. Universal HealthMart will offer a variety of comprehensive plans and entitle every American to the same benefits and types of plans as Members of Congress.
  • Universal Affordable Coverage. Under the Dodd plan, coverage will flow automatically to all Americans regardless of their employment status, health status or economic means. Coverage will follow people, not their jobs. Enrollment will be automatic unless individuals and employees choose to have insurance outside Universal HealthMart. Coverage will be phased in over four years. As more and more Americans participate, Universal HealthMart will gain increasing leverage to negotiate premiums and lower costs. Price discrimination based on condition will be eliminated.
  • Better Care for Kids: Under the Dodd Plan, every child in America will have guaranteed health insurance equivalent to the health coverage Members of Congress have for their children. All children will have access to preventive health screenings including vision, hearing, autism, and other neurological disorders.
  • Portability. Health coverage will be portable as it follows individuals, not jobs. Regardless of where people live, they will have access to and be able to maintain their Universal HealthMart insurance. Universal HealthMart health care will carry across jobs as long as employers participate in the system.
  • Automatic Coverage. Coverage will occur through direct enrollment or automatically when people file their tax returns, complete W-4 forms, or show up for health care with a provider. Through the process of automatic coverage and enrollment, universal coverage will be guaranteed.
  • Choice. Every American will be guaranteed a number of comprehensive health coverage options in the Universal HealthMart. Individuals will gain the ability to choose for themselves and their families the kind of health plan they want. The choice no longer needs to be in the hands of employers whose primary interest may be controlling costs.
  • Focus on Prevention. The Dodd plan will focus on chronic disease management and preventive measures. People who make personal choices to improve their health through smoking cessation, weight loss, and exercise will have access to plan rewards and incentives. Chronic illness will be prevented and treated through an integrated system of chronic disease management modeled after the system used by the Veterans Administration and outstanding private delivery systems. Within Universal HealthMart, this care model will employ the most innovative methods of care coordination including interoperable health information technology and coordination between providers and levels of care.
  • Lower Costs for Employers. In addition to realizing the benefits of reduced premiums brought on by the bargaining power of Universal HealthMart, employers who participate in Universal HealthMart will no longer be required to negotiate insurance premiums or shoulder the costly task of administering health plans. Employers and their employees will have guaranteed access to a variety of plans and will contribute based on their ability to pay. Better and guaranteed coverage of employees will result in better health, less absenteeism, and higher productivity.
  • The Power of Technology. The Dodd plan will lower administrative costs and eliminate inefficiency by investing in technology and data collection for better care. Better use of interoperable health information technology will reduce administrative costs, improve quality, and enhance coordination of care. Widespread use of information technology will provide the mechanisms for monitoring and improving quality. In addition to improving quality and enhancing the coordination of care, incentives for using technology will also result in further cost savings and lower premiums.
  • Affordability. Savings in better care and better efficiencies will help finance new coverage. Premiums will be driven down for employers and employees as negotiators bargain from strength on behalf of a large pool of people and businesses. In exchange for a larger market and a lot more customers, most of whom are pretty healthy, the insurance industry will be forced to end price and coverage discrimination against people who need medical care.
  • Funding. Universal coverage will not require a new tax. Instead, much of the plan can be paid for by eliminating the existing inefficiencies in the system. Universal HealthMart will be financed primarily by employer and individual premiums and contributions. Other revenue streams such as those that would result from ending the war in Iraq will be identified for transition costs.
  • Easy to Accomplish. The Universal HealthMart model, the Federal Employees Health Benefits (FEHB) Plan, already operates in every county in the country.
  • Action now. Universal coverage is an important priority for our productivity, our economic growth and the lives and health of our people. Within two years of enactment the Dodd plan will phase in universal coverage by age group based on current levels of insurance and health need. Within two years of enactment, all children, young adults to age 29, and adults age 55-64 will have health insurance. In the following two years, all remaining adults age 30-54 will be enrolled.
  • Existing Public Insurance. Under the Dodd plan, Medicare remains intact but will be given power to negotiate with pharmaceuticals on the cost of prescription drugs. Medicaid will also remain intact. All people under 100% of poverty will be eligible for Medicaid with adjustments in the federal match to hold states harmless.

Addtional details are available on Chris Dodd's website.

In a conference with the media after the announcement, Dodd commended John Edwards and Barack Obama for introducing their own proposals to achieve universal health care coverage, but faulted the Obama plan for lacking a clear path to coverage for all, and said Edwards' proposals fell short in envisioning regional, rather than national coverage plans, and also in requiring a tax increase. Senator Dodd maintains that his plan, which he says would cost $50 - $70 billion over the four years required to implement it, could be paid for without increasing taxes, mainly by using money that's currently being spent on the Iraq war.

My initial impression is that Dodd's plan is a very, very conservative approach that relies on the existing health insurance market to bridge gaps primarily created by that very same system. The Universal Healthmart Dodd proposes seems little more than the type of federal buying pool long discussed as a means of reducing insurance premiums and pharmaceutical costs. There's nothing here that would set the insurance industry or American Medical Association trembling in their shoes, certainly. Senator Doodd is right when he identifies health care as an issue of deep concern to Americans, but I suspect many who look at his proposals will wonder how you fix the existing system while at the same time going out of your way not to rock the boat.



Days Until Bush Leaves Office = 543

Non-native Iowan that I am, I must confess that the annual RAGBRAI bike marathon across the state has never held the mythic stature with me that it does with others who have lived here their whole lives. Don't get me wrong, I think it's a cool event, but to hear some talk of it, you'd think it's right up there with the Iliad, rather than roughly on par with the Butter Cow at the State Fair.

[Now having cleared the room of native Iowans, let's continue, shall we?]

I first heard about RAGBRAI more than 20 years ago, back when Bruce Babbitt was tooling up for his White House run and hit upon RAGBRAI as the ultimate Iowa "get to know you" event. Babbitt rode the entire route, almost 400 miles, and summed up the experience by muttering, "They told me this state was flat."

Ever since Babbit, at least one or two candidates have saddled up for RAGBRAI each presidential cycle (excuse the pun), although so far Babbitt is the only one to have gone the distance. This year, John Edwards spent a day in the saddle, hanging with Lance Armstrong, and Joe Biden deputized his wife, Dr. Jill Biden, and his niece, Missy Owens, to ride on his behalf.

What riding in RAGBRAI actually buys a campaign has never been entirely clear, beyond some free media some six months before the caucuses (a lot more important back in Babbitt's day than in this year's insanely accelerated race). But it's nice to see the tradition hold up, all the same.

Here are links to coverage of the experiences of this year's political RAGBRAI-ers:

John Edwards
Jill Biden


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