John Goodman on a new Health Reform Proposal

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Summarized here. Twelve points, including

Health Status Insurance: For the first time, people with pre-existing conditions will have real protection against discrimination and against the “race to the bottom,” reflected in narrow networks and high drug costs for the chronically ill. Risk adjustment between health plans (similar to Medicare Advantage) will insure each plan receives an actuarially fair premium when receiving an enrollee from another plan. (Plans will not benefit by seeking the healthy or avoiding the sick.) Plans are free to voluntarily agree to better risk adjustments, so there will eventually be free market risk adjustment. We expect plans to eventually specialize, with some plans becoming focused on cancer care, others on heart care, etc.

…Grandfathering. To minimize potential disruption, self-insured employer plans and labor union plans may elect to remain in the current tax system. Individuals with insurance obtained from an (ObamaCare) exchange may elect to remain in that system.

The latter is this proposal’s version of “if you like your plan, you can keep your plan.”

I happened to run into John last week, and he was very enthusiastic about the plan. I expressed my doubts about something like this getting anywhere with a Trump candidacy, and he said that he was actually optimistic. But when I pressed him, John admitted that “Trump is hard to get to see.”

4 thoughts on “John Goodman on a new Health Reform Proposal”

    • They might be marginally easier to see, let’s say, just for fun. But they are also less likely to consider ideas, even ones that would match their worldview, which Goodman’s wouldn’t, of course. So, we must speculate on whether Trump would fall on the wonky side or the “get tough” side if and when he does start to delegate. It’s unknowable.

      • “If you must choose between two evils, pick the one you’ve never tried before.”
        — Steven Wright

  2. In Dr. Goodman’s proposal, health insurers would owe each other money if a sick person went from one carrier to another.

    The carriers are losing money now in the individual under-65 market. They will run for the exits even faster if they start incurring debts when people lapse coverage.

    There is nothing wrong with the concept of risk adjustment, in order to keep markets stable. It is used in most countries, including in America for Medicare Advantage.

    But it takes enormous amounts of tax dollars to be effective. Dr. Goodman underplays this key fact.

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