Tuesday, January 8, 2013

Before Obamacare, Utah Lawmakers Singing a Very Different Tune

Ran across an interview by KUED as part of their Healthcare: Facing the Barriers documentary.  Contrast today's staunch opposition to Obamacare and the Medicaid expansion with Sen. John Valentine, 2007:

By making it more affordable, you have a way to be able to get insurance.  Let’s use an analogy of a car.  Not everyone can afford an Expedition--a large SUV.  But most people can afford a smaller car.  If they can't afford a smaller car then perhaps they have to take public transit.  Now some of us will go in and out of the various different systems.  For example, I'll take my large SUV up to 106th South and get on tracks to go down to a Jazz game or go down to the Symphony or to go to Temple Square because it's more efficient to take that, it's faster oftentimes and I don't have to find a place to park.  So you use various different aspects of the system based upon what is going to work for you on that particular day.  Well healthcare can do the same thing.  You can have a healthcare program that has a basic system and if you want to afford add-ons, you can buy the add-ons, but everyone should be able to afford a basic system--that's the view that Utah would like to put forward.

The view 2007 Utah would like to put forward sounds a lot like a public option, and exactly like Romneycare in MA, a program Obamacare borrows heavily from especially regarding expanding access to reduce costs associated with a high number of uninsured.  An idea 2007 Valentine also endorses:

I would start with a basic policy that could be affordable for all Utahans.  It would be a basic policy.  It would not have a lot of the bells and whistles that we keep mandating to insurance carriers.  On that basic policy, the premium on it would be means tested, in other words, depending upon your income would be dependent on what you'd have to pay for that policy.  That policy would be available to everybody above the poverty line.  People at the poverty line would be covered by Medicaid--that's a federal program that the state participates in.  I wouldn't change that part of it.  But it's for those uninsured Utahans above the poverty line, but not able to obtain insurance through their own employer.  That basic coverage would be just that--it would be very basic.  It would not have a lot of the things on it that people expect with insurance when they have expectation of full indemnity, in other words it covers everything.  But that basic policy would provide a basic coverage for everyone to be able to afford.

Sen. Valentine also endorses a collaborative effort between states and the federal government to expand access and reduce premium costs.  While true to his conservative nature opposing mandates and "Canada-care," 2007 Valentine draws a stark contrast with the position of Gov. Herbert and many legislators expressed today.  "The states can't go it alone," 2007 Valentine says, without hesitation.

Is the takeaway here that, uninsured be damned, a good idea is only a good idea if "our guy" is in the White House?  If expanding Medicaid was a good idea in 2007, it's only a better idea in 2013 as costs have continued to more than triple in Utah.


  1. Lost in the discussion, again, is what to do about costs. Here's a fun exercise: call up various medical providers and ask for a quote on a routine procedure. I'd bet lunch that less than half would actually be able to give you a price. What I fail to see is how giving insurers more power (which is what the ACA does) addresses this growing problem.

    The reality is that there are a lot of jobs and dollars on the line if we make any kind of sweeping changes in the system. Hospitals will close and people will be unemployed in massive quantities as the end result of operational efficiency. Instead of accepting that price of innovation, the medical world has created protectionist arguments the same way that the entertainment industry does.

  2. Average doctor in the US has 4 administrative personal working just for insurance billing, The Average hospital has 1 administrative personal for EACH hospital bed, just for insurance billing.

    Administrative overhead is the number one driver of costs bar none.

    Doctors and hospitals in the USA also have around a 20% uncompensated care rate, a loss rate that would bankrupt any other industry.

    Obamacare certainly doesn't do enough, but it does hit both issues, though administrative costs much more lightly then uncompensated care costs.

    And I would also note that Obamacare is completely paid for, and in fact reduces the size of the deficit.

    "Hospitals will close"

    I know you live in the protected little hamlet of Utah, but in fact Hospitals in the larger States have been on the verge of bankruptcy for years, increases in uncompensated care costs have force the larger States to expand their medicaid programs with State money without federal help to avoid these problems.

    "What I fail to see is how giving insurers more power"

    Certainly I can agree with this, but I don't see any reasonable alternatives coming from you, or anyone in the right wing for that matter.

    I propose a French style all payer system.