June 8, 2010
Few Health Reform Options Would Have Covered More People at Lower Cost Than New Law
The recently enacted federal health care reform law provides health insurance coverage to the largest number of Americans while keeping federal costs as low as reasonably possible, according to a new analysis from the RAND Corporation.
The only alternatives that would have covered more Americans at a lower cost to the federal government were all politically untenable—substantially higher penalties for those who don't comply with mandates, lower government subsidies and less-generous Medicaid expansion, according to research published in the June edition of the journal Health Affairs.
Researchers simulated more than 2,000 different policy scenarios using the RAND COMPARE microsimulation model, which was designed by RAND to provide independent analysis about how different reform proposals would impact the American health care system.
"Of all the proposals on the table that would expand health insurance to more Americans, the final health reform law included those that covered the largest number of people at the lowest cost to the federal government," said Elizabeth A. McGlynn, the study's lead author and a senior researcher at RAND, a nonprofit research organization.
RAND article in Health Affairs:
Prior qotd on RAND COMPARE:
Comment: RAND created a microsimulation model called RAND COMPARE that was designed to "provide independent analysis about how different reform proposals would impact the American health care system." Using this model, Dr. Elizabeth McGlynn concludes, "Of all the proposals on the table that would expand health insurance to more Americans, the final health reform law included those that covered the largest number of people at the lowest cost to the federal government."
On a RAND Webinar event held in January of last year announcing the release of RAND COMPARE, I noted that a single, public insurance model (single payer or Medicare for all) was not an option available on the RAND COMPARE website. Dr. McGlynn then assured me that it was a model that should be added. In followup, others also contacted RAND to request that this model be added, and they received assurances that the matter was being addressed.
If you check the RAND COMPARE website, you will find that they did add well over 100 legislative proposals before Congress. They marked each proposal as to whether or not they addressed specific policies evaluated by the RAND COMPARE model. Some of the policies considered included individual mandate, employer mandate, tax credits, Medicaid eligibility, high deductible health plans, bundled payment, comparative effectiveness, and others. In the chart, H.R. 676, John Conyers' Medicare for all bill received no marks whatsoever, as if it did absolutely nothing under the RAND COMPARE model.
Everyone who understands the single payer model knows that the final health reform law will not cover "the largest number of people" since single payer would have covered tens of millions more - that is, everyone. Also the single payer model would be far more effective in slowing health care cost increases than would the legislation enacted. RAND dodges this by repeatedly stating that the bill represents the "lowest cost to the federal government," but it is our total national health expenditures and not the federal budget that matters.
The slogan for RAND COMPARE on their website is "Facts you can use, analysis you can trust." Well, that sounds "Fair and Balanced." It's only people who need health care that are being victimized.