It’s actually useful in providing a snapshot of the current financing streams, but it actually could be more descriptive (and thus messier). We could add SCHIP alongside the Medicaid box, indicate the relative size of employer-provider care (over 50%) compared to other sources, provide a greater description of the mess of the individual insurance market (it looks the most straightforward, when in fact its the ugliest), separate the “health plans” box by type of plan, if not by company, and somehow include the funding streams for “safety-net” providers (and we’d probably need to include county government as well).
To all this complexity, Ezra writes: “Tell me again how national health care would be layered and complex as compared to the sleek elegance of our current composition.”
His point is a good one: I remember New York Senator Al D’Amato running around in 1993 with a chart of the Clinton health reform plan that was made to look like spaghetti night at Rube Goldberg’s. Yet no one ever compared that chart to the mind-numbing complexity of the status quo, which is the appropriate comparison.
But I think this chart makes the opposite point as well. Health reform will necessarily be complex–perhaps even more complex than this chart, because this is where we start from. Even a transition to a super-simple single-payer system, which I would support, would involve a transition that had to manage disentangling these financing streams, which would include excruciating policy acrobatics. President-elect Obama’s plan proposes providing more options–and so potentially more complexity–for consumers and employers, from new purchasing pools to a public plan option.
This isn’t necessarily a bad thing. An iPhone is a complex device inside, but it is an elegant device that is simple to use, and that’s the main goal. Sometimes the system has to be more complex internally to provide a simpler consumer experience.
My main point: Having a purchasing pool that standardizes benefits, ensures a basic level of quality coverage, negotiates for the best deal, collects and computes consumers’ potential subsidies and tax breaks, and organizes your options in an easy-to-understand manner–all that may be a complex undertaking, but it would provide the real administrative simplicity that many consumers seek. That’s what missing from our current, chaotic health system.
The goal is to make coverage not just available and affordable, but administratively simply… if not automatic. And if it takes complexity to get there, so be it.