Time to Fuck with the Candidates...Because It's Our Job

When I woke up this morning, I knew it would be a great day to fuck with the candidates.

The candidates are getting more detailed in what they're willing to share in terms of health care reform.

For both democratic candidates, reform is a priority "...with the stated goal of providing coverage for everyone."  Yeah, yeah.  We get it.  I like it.  But is anyone thinking about funding?  Everyone wants to maximize their share of the health pie.  What happens to access if we don't have any statement about funding and how primary care reimburesements will have to increase?  (What about rationing?  If anyone has a way to do this without rationing, I'd love to hear it!)

The republican candidates want reform too (if you don't, you won't get elected). If we just make health care more affordable for the uninsured by providing "...subsidies to help people with modest incomes buy health insurance." Yeah, like that's going to change spending patterns. We know that people tend to decline coverage options via their employer if it involves even modest outlays--it's because they're deciding about covering costs of living and making mortgage payements. You can't blame them for making the same choice. So this solution is worthless (mandates don't work, either, by the way).  

Huckabee's just a fucking joke when it comes to healthcare....the article I linked to just sugar coats it.

The biggest potential challenge with all ideas is that unless everyone has to participate in the same risk pool, (or at least in geographically distributed risk pools that each require everyone to participate), then there will always be selection bias.  Sicker and "less desirable" patients from the standpoint of impact on medical loss ratio will have no choice but to migrate to these defaults.  The healthier (wealthier? white?) individuals will also self-select.  Anyone who thinks you can manage a risk pool with having sufficient healthy patients (low-utilizers) in the pool is smoking crack.

Regarding the republican candidates' proposals, how the hell can you decrease insurance industry regulations and also ensure that selection bias doesn't take place in terms of who's "insurable" and who's not?  The "who's not" category would be less profitable, and thus less insurable.  Even if you don't link premiums to health status, there are clearly ways around this.

Regarding McCain's tax credits, $2,500 for an individual and $5,000 for a family won't cut it.  Seriously, $5,000 for a family?  As it currently stands, my family would burn that up in 6 months (I contribute a portion to my employer's coverage).

Pessimistic...yes.  I think there's still a very large commitment to the future success of the health insurance industry.

"The candidates also have largely sidestepped the hard choices and tradeoffs that many economists contend will need to be part of any significant health care reform.

That includes the pending fiscal collapse of Medicare, projected to be insolvent by 2019."

In any case, I'm definitely glad that health care is taking center stage in this election.  I'm also glad that the candidates are getting to a level of detail that can lead to good debate.

But just in case you were wondering, I think we're fucked for a little (?) while.  Not enough pain yet to motivate action.