Wednesday, March 23, 2005

Center for American Progress Releases Health Care Proposal

The Center for American Progress, a think tank with some Clinton ties, has come out with a new heath care proposal. I have only had time to look at the proposal quickly. On first impression, one of the best things I can say about it is that it is certainly not a reintroduction of HillaryCare. Like the plan proposed by John Kerry during the 2004 election campaign, this plan starts with existing health plans and acts to make them more affordable.

The program does depend a lot upon extending Medicaid to low income individuals, which may be more realistic than a more extensive program but is far from desirarable. Wherever possible, I prefer plans which extend Medicare coverage rather than Medicaid.

In comparison to Kerry's plan (with information still available at the Doctors and Nurses for Kerry web site) I see a couple of concerns on quick review. The plan proposes to take preventative services out of the insurance system and start a new benefit plan. In practice I find that once there is a question of which of two plans is to cover a service, chaos often results and nobody winds up paying. There is not an absolute dividing line between what is preventative and what is normal care for a disease. If I draw a Lipid Profile on a diabetic patient (who typically have abnormal lipids), is this part of standard care for the patient to be covered by their ususal insurance, or is screening for lipid abnormalities to be the responsibility of the new preventative service system? I prefer Kerry's approach of encouraging traditional insurance plans to cover preventative care.

They suggest paying for these benefits through a new Value Added Tax. I fear this would be a much harder sell politically than Kerry's suggestion of rolling back the tax cuts on those making over $200,000 per year. There will be plenty of opposition to setting up an entirely new tax system, and the fear that once a small Value Added Tax is initiated to pay for this, it will follow the path of most taxes and continue to grow.


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