Sunday, March 21, 2004

Expanding health insurance through the state government

(Instead of getting some work done in the office today, I'd rather write about some innovative progressive public policy on how to expand health insurance. No wonder I'm broke. So, here goes:)

As the federal government is run by the corporate wing of the Republican Party, state and local governments are the places where we can expand health insurance. What are some good ideas out there?

Howard Dean had some good ones. In this interview, Dr. Dean says that states should cover everyone under the age of 25 through Medicaid, and the feds should pick up the cost of all seniors in Medicaid. I like the idea of the state covering everyone under 25 through Medicaid. Apparently, Vermont already covers everyone under the age of 18. Not sure how that happens.

In Illinois, the medical malpractice insurance is driving some doctors out of the state, especially in Southern Illinois. This is a growing issue; here's an article from Alton, Illinois that explains that one of the two Alton hopsitals might close because so many doctors are faced with very high insurance costs for medical malpractice.

So, the Republicans would like to cap medical malpractice jury awards, thinking that if a jury can't award a victim of medical malpractice $10,000,000 or so, then the insurance rates would go down. The Illinois General Assembly can cap those jury awards, and there are groups pushing to do just that, led by the Illinois State Medical Society (here is their fact sheet on the issue). When the Republicans ran state government in 1995 and 1996, they passed a cap on punitive damanges on jury awards, but that cap was declared unconstitutional by the Democratic-controlled Illinois Supreme Court a few years later. I'm not sure if medical malpractice caps would be constitutional under the decision. The Illinois Civil Justice League is a Republican group also arguing for caps and other reforms.

So, if it is possible to impose some sort of medical malpractice cap, what do we progressives get in return? Maybe universal health coverage. Maybe we put a cap on the tax expenditure spent on private health insurance plans to bring in more revenue (in other words, if a company buys a hugely expensive health care plan for the executives, all that expense is deductible from their state income tax, so they pay less in state income tax). We could put a cap on that state subsidy of private plans, to help fund universal coverage through expanded Medicaid.

One problems is that some Illinois physicians get sued over and over again, but they don't get their license yanked, according to this report by Stephen Roth.

The Illinois Hospital Association reprinted a good roundtable from the Joliet Herald-News here. Some good ideas that jumped out at me from the liberal Coalition for Consumer Rights: reduce actual malpractice through a more transparent, more aggressive Department of Professional Regulation that can yank the licenses of bad doctors. They have a report here on that topic. That seems like common sense to me, but just getting sued probably isn't the best indicator of a bad doctor. Then again, what's a better indicator than that? Maybe if we had more evidence of actual mistakes made by physicians, we'd be in a better place to know which doctors are bad. Seems like a smart state policy to force more disclosure of actual medical errors.

Well, that one took a different path. If anyone has other good ideas about expanding health insurance, send them over.

No comments: