Mar ‘11
14
The Durenberger Response
My first health reform bill in the Senate was the Consumer Choice Health Act of 1979. It didn’t pass, but, in principle, it advocated employers provide employees a choice of at least three health plans, including an HMO, in order to qualify for the income tax subsidy for both employer and employee. People need financial incentives to stay healthy and to make wise choices of plans and providers. Private plans can provide the risk-bearing coverage as well as the information services consumers and providers need these days.
Vouchered public subsidies are better than the current system or the HSA – which are reverse income related – they reward the wealthy and the purchase of too much insurance and too much healthcare. What’s missing from the current system is the information every purchaser needs to make choices and the financial resources that enable informed choice and the appropriate service response.
Built into the A.C.A. are all the tools any state or any community or any region in the country needs to get on with the business of informed consumer driven health care. Since only 52% of Americans today can always count on having public or private insurance, the commitment by the national government to universal coverage is critical to removing cross-subsidy and cost-shift barriers to efficient quality care from integrated care systems and individual providers. All the other national goals in the A.C.A. are just that. They are goals we have fought for and over for decades. Health improvement, reducing the social determinants of poor health, healthcare payment and insurance reform.
Second, these can best be developed, with the help of national resources, at each of the distinct practice cultures in America. Some of them are in states like Hawaii, or Utah, or North Dakota. Some are distinctly regional like northern California, or the Pacific Northwest, or the Upper Midwest, and some are more local like Grand Junction, CO, or La Crosse, Appleton, and Marshfield, WI. All health care’s local. We’re just waiting to show Obama and Pawlenty the way.
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