Friday, November 19, 2010
I basically agree with Reihan Salam's take on the Wyden-Brown's proposal. I think it would be great to enable states to experiment on health reform by giving them a waiver and letting them implement their own reform but the waiver process is essentially worthless if there is a requirement that the insurance that is offered is as comprehensive as envisioned in the health care bill. Reihan's objection is one I share more broadly with the entire health reform effort which is in order for a state to qualify for a waiver the state must ensure that the insurance is as comprehensive as the health care bill offers. I think that is the central failing in the health care bill which is that in maintains a system of comprehensive health care coverage when we should in fact be shifting away to a system of catastrophic coverage. What if for instance, a state said that it wanted to take the the funds and implement universal catastrophic coverage for everybody and health savings accounts for medicaid eligible population and spend any savings on things that would constitute wellness or public health improvements. This could be as varied as increasing budgets for healthier school lunches, better and more extensive public transportation, promoting walkable communities, expanding community clinics or just return the savings to the people in the form of lower taxes.