Universal Coverage Matters More

At the moment more emphasis is being placed on extending health care coverage than on cost containment. I would argue that this is in fact the correct position from a political standpoint. Once coverage is expanded it will be extremely difficult for future lawmakers to diminish it, and it will also put additional pressure on the cost problem. This is certainly worrying, but I believe that in practice it takes a real crisis to prompt serious reform owing to our onerous system of checks and balances and special interests. Costs are out of control so action on that front must come; universal coverage, however, is much less of a sure thing.

Should Financial Reform Have Come First?

The Obama administration has attempted to use the financial crisis as leverage towards tackling health care reform, but it's possible that financial reform should've come first. With the economy improving a lot of the impetus for reform is already waning and a recovery of some kind was not entirely unexpected. Additionally, all the expenditure on bailouts has made the discussion of further public funding of any large initiative more difficult. Health care under the current system is only going to get worse, so time isn't a factor on that score. These factors seem to indicate that regulatory reform should've preceded health care and we're already seeing a considerable retreat on my areas of reform. Perhaps the Obama administration was counting on continued high unemployment (as it's a lagging indicator) to keep up voter outrage and maintain pressure on legislators. Since large deficits and an aversion to spending will persist for some time, it may have been seen that there was no benefit to waiting on health care reform and capitalizing on honeymoon period popularity was the best strategy. I find myself extremely skeptical that their decision was the correct one.

Independent Non-Profit Public Health Care Option

Much of the debate about health care reform has centered on whether or not to have a public option. Simultaneously some are arguing that it would be very inefficient, but at the same time be cheap enough to put private insurance companies out of business. On the face of it that seems absurd, but one reasonable objection I've heard is that a government system would be subsidized in a way that would give it an unfair advantage. Another expressed concern is that a public option's sheer size would give it bargaining clout to negotiate lower drug prices. I don't feel that's a valid objection as not only is that a good thing, but also private companies could in theory band together in their purchasing. I believe that the public option should be a non-profit business set up by the government, but then run as a separate entity. Its charter would direct its policies, but it would not have the onerous requirements of being a government agency. It should be allowed to fail if it performed badly, although initially it would require some public investment to become established. To further reduce the temptation for it to be bailed out and to add more competition, in theory multiple non-profits could be set up although that should probably be considered only after the first one was successfully in operation. I am developing a system for blending public and private activities in general and will post about it once it's more fleshed out.