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What Would Olympia Snowe's Trigger Look Like?

Jon Cohn Suzy Khimm has the deets.

By Ezra Klein  |  September 9, 2009; 10:05 AM ET
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a sensible trigger is the best option I can think of to rein in costs without the eventual government and its waste taking over the system. The insurers kept costs in line in the 90's and can do so again. It just means we can't have that 3rd MRI in a year's time to make sure the cancer hasn't re-occured. We need to take the generic drug and actually see if it works before we take the brand name drug only if we have a legitimate AMA guideline rule that shows we should have the brand name drug. We also need to keep insurers profits down (which a loss ratio does) and look closer at who owns hospitals, doctor practices, stakes in labs, etc. The profit motive of some that supposedly have our best interests at heart are very questionable and more light needs to be brought on this subject.

I'd be interested to see stastics if they are available of percentage of proceudres (ie MRI's) that were denied in the 90's as compared to today. I'm sure that would shed an example of how we can cut costs in a reasonable manner without sacrificing public safety. I don't think more people died in the 90's from not receiving care from insurers than are dying now from being unable to afford care and its spiraling costs.

Posted by: visionbrkr | September 9, 2009 10:44 AM | Report abuse

And I thought the WaPo was a family newspaper...

Posted by: dfrankiswork | September 9, 2009 11:09 AM | Report abuse

for this evening,
blessings for barack obama.

if we hold on to our differences, instead of conceding to common ground, our stubborness will take us down.
if dogs in an iditarod run off in every direction, they cant win the race.
everyone must find a way to help this president,
or all will be lost.
and life will be very much worse for all of us.

there is a time to fight.
there is a time to make peace.
there is a time to know the difference.

and acceptance for what is possible in this very real, extremely complex, broken and hazard~filled world.
that is the only way.

prayers for barack obama, that he does not become spiritually discouraged by the negativity that swirls now like a vortex.
i pray that he will walk in victory.
blessings for our president,
and for this country.

Posted by: jkaren | September 9, 2009 11:24 AM | Report abuse

What's that guy say on TV? "I'll beat anyone's price or your mattress is FRREEE!!"

How many free mattresses do you think he gives away?

Posted by: bmull | September 9, 2009 11:29 AM | Report abuse

Visionbrkr makes the excellent point that if we are going to reform the health care system in general and bring costs under control in particular we are going to need a system of rules imposed on the insurance industry and on health care providers and hospitals from the outside. That is the system that has been adopted successfully in many other countries, including Germany, France, Switzerland, the Netherlands, Japan, and others. Their systems depend on private insurance, but the insurance system is controlled by very strict government rules.

As he notes, the insurance industry itself has been unable to impose restraints on the system. They tried and failed in the 90’s, and continue to fail today. Medicare is somewhat more successful than private insurance at restraining cost growth, but is still a miserable failure because of its vulnerability to pressure from lobbying groups that have successfully derailed most efforts to control costs. Hospitals and other providers have certainly shown that with few exceptions they are unable to contain costs.

If runaway costs are left unchecked Medicare, Medicaid, and private insurance will all face financial crises that will make it impossible for most Americans, including the entire middle class, to afford good health care. The costs will become insupportable and exclusionary systems like very high premiums, co-pays, and deductibles will be the only choice left. Employer health care will become unaffordable, and costs will price most people out of the system.

The most important single feature of any reform is the creation of an independent scientific commission to create standards of care that will require effective measures to improve care but prevent waste on ineffective or inefficient care. The rules need to be applied to both government and private programs. That will give cover to insurance companies, Medicare, doctors and hospitals, and politicians to take the steps needed to protect American health care without fear of competition, law suits, public pressure, or other forces stopping rational approaches to health care. The creation of this type of mechanism is more important than the shape reform takes, since regardless of whether we have public insurance, private insurance, or even a single payer the system is doomed unless costs are brought under control in a way that protects rather than excludes people.

Posted by: PatS2 | September 9, 2009 11:38 AM | Report abuse

Snowe's idea isn't really that bad as excplained in TNR, except that it would be simpler if the trigger simply allowed people to buy into Medicare.

Having the insurers have to file their prices a year in advance, and having it take effect before the reforms do is a great incentive. If a group like Kaiser Permanente, which is a non-profit, would qualify, it would actually be ok with me. If progressives beef up the safety net plan and the circumstances for the trigger, it could actually end up being better than what's in the House bill after Energy and Commerce.

Plus, it has the added virtue of making people put up or shut up. Those who believe the privates can compete will give them a chance to prove it, and those who don't will get the alternative when they don't.

And it sounds like an on-going thing, not something that would be triggered once or never, so any time the insurers fail in a state, they have the competition. And we can see how it fares in a few states first.

Posted by: Mimikatz | September 9, 2009 12:03 PM | Report abuse

"The most important single feature of any reform is the creation of an independent scientific commission to create standards of care..."

From what I hear this is precisely the #1 thing that industry stakeholders *don't* want. One of them said he would rather have single-payer than a stronger MedPAC.

Posted by: bmull | September 9, 2009 12:09 PM | Report abuse

bmull -- "From what I hear this is precisely the #1 thing that industry stakeholders *don't* want."

No doubt.

One person's waste is another person's yacht.

If we do cut waste in health care, it will take money out of the pockets of drug companies, equipment manufacturers, hospital executives, and doctors.

Rent seeking is old news in health care.

Posted by: PatS2 | September 9, 2009 9:31 PM | Report abuse

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