From foundational details to 10,000 feet view

The recent spate of news stories about health reform have been all over the map. Today’s stories include a USA Today article by Julie Appleby, and a San Francisco Chronicle article by Carla Marinucci and Tom Chorneau.

They all try to take a look at this issue through a political lens, rather than the policy. My point in the Chronicle article was that if we are going to have a health care debate, we are going to need to actually debate some of the key policy elements, and that’s healthy. It’s too late in the year to only be talking about the broad areas of agreement, when there are major, outstanding issues that the Governor has yet to make any gesture on.

I was amused that some of the commentators in Chronicle article were political operatives, trying to make a political point. So I was amused when they tried to compare the Clinton plan with the Schwazenegger plan: they are similar in their overall themes, but the debate is over core details. And one can get whiplash going from the very advanced California debate fove years in the making, to the very vague and preliminary DC debate.

One of the debates on the Scwarzenegger plan is the very definition of what is “coverage”–is it a $5,000 deductible catatrophic plan and that’s it (as in the January proposal)? or worse (as in last week’s proposal, which hass no standard, and the ability to have sub-minimum plans through an employer)? This is a “detail” that none of the presidential candidates’ plans, including Clinton, even mention.

These are not policy wonk details: real people will think very differently about a proposal that seeks to provide comprehensive coverage, versus one that requires skimpy coverage. But the presidential plans don’t go into that–althrough given how much they talk about not just the uninsured but the underinsured, I would be surprised if Clinton or Edwards or Obama came up with a $5,000 deductible plan as the standard.

It’s the difference between looking at a house from an overhead GoogleEarth shot, or being able to walk in and inspect it, it’s foundation, its heating and cooling systems. You gotta be able to ask those tough questions, and see if they are fixable, or not. You could decide whether to buy the house if the “details” work out–or not.

We’ll see if the Governor gets the message, and finally suggests some affordability changes to his January proposal.. That’s what we need to keep the momentumg going.

Health Access California promotes quality, affordable health care for all Californians.

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