The Health Care debate between Jack Markell and John Carney started abit late on Friday morning — a good thing, since I was running really late. The auditorium was pretty much full (but not as many folks as at the Education debate), and this crowd was abit more sedate.
The News Journal has written this event up, so I won’t go over all of that ground, but it was interesting to me that Markell was abit more aggressive in this round. He started right out noting that Carney had served on health-care related commissions and task forces for almost a decade, but coverage of Delawareans continues to deteriorate, and costs continue to spiral upward. Markell set up his theme — that the health care situation in DE needed to be dealt with quickly and decisively, and that the era of incremental changes on the way to a larger goal was no longer a functional approach. Carney, then, spent the rest of the debate trying to tell the audience that his plan was not incremental steps — but he couldn’t avoid the step-by-step narrative that he’d already set up. In my opinion, Markell ended up looking like the guy ready to take some political risks to get to long-term solutions, and Carney was extending the work of his commissions and committees. Carney had the advantage, I think, of having many of his colleagues from some of these commissions and committees in the room.
Several of the major features Markell’s plan seem to resemble the Massachusetts plan implemented almost 2 years ago. While the MA plan has enrolled something like 300K people into its multiple plans, the adoption rate has been higher than expected, significantly increasing the insurance subsidy costs. And those costs will continue to increase as care costs rise. The insured are expecting a 10% increase in premium costs this year. And not everyone has insurance — 20% or so of the uninsured currently have waivers from the mandate requirement while the state figures out how to pay for them, too. The MA plan doesn’t do much to address cost containment of care, either.
Markell does account in his plan for full enrollment of all 100k+ Delaware’s uninsured. It is less clear about medical cost containment, relying on broad initiatives (wellness, info technology, pharmaceutical cost negotiation) that may reduce overall system costs over a long horizon. And given how fast medical costs do increase, it seems fair to want to know how by how much these initiatives will slow those increases. You can’t tell — really — how the state subsidy gets paid for. Those of you with better info should chime in on this.
Carney’s plan showcases the idea of being the first start to provide universal subsidized access to preventative and primary care to the uninsured. He thinks that this will start small and grow, meaning that it won’t need a great many funds early on. He focuses on wellness programs and educating Delawareans in options to take better care of themselves. His plan to pay for this (or even to get to full service universal care) is really murky (and non-existent on his web site). Again, those of you with better info should chime in on this.
Markell’s program presumes to get everyone insured who does not have insurance, but am not sure how he incorporates the lessons learned from the MA implementation. Carney’s program could be the beginning of a Road Map to Single Payer, but once he gets his primary and preventative care program up and running it is not clear what he does next — if anything.
What do you think? Does either plan have advantages that I am not accounting for here? What do you think of the approaches by either candidate to pay for their plans? Is there an ideal plan plan out there? And if there is — this is critical — how does it get paid for?