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October 08, 2007

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Charley on the MTA

David, a good-natured challenge for you: Go to the Massachusetts Health Connector, find some plans, and imagine making between $40-60k (as an two-income family -- half that for a single-income family) and trying to afford the family plans.

And then report back to us if you still think that the need to subsidize 200-300% of FPL is "not clear." Massachusetts decided to do so -- correctly, IMO.

David Eisenthal

For me, the public policy goal of SCHIP should be to make sure that children who would be otherwise uninsured or underinsured get coverage.

Yes, unsubsidized health plans are expensive for middle income familes, but I'm not sure the extent to which kids are going uninsured because of it.

My larger point, though, is that if we establish the need to subsidize insurance for these kids, we need to find a better way to pay for it than the cigarette tax - and Congress needs to be more straightforward about the costs - and their contribution to the federal deficit.

Peter Porcupine

David - I am commenting here rather than on BMG, as the discussion is more on-topic.

I am wary of the SCHIP expansion for the simple reason that we have not, and to a certain extent cannot, cost out the expansion. We need to be more wary, not less, of expanding entitlement programs.

A local example - look at the growth of senior prescription drug government benefits from Senior Pharmacy under Cellucci, to Prescription Advantage under Swift, to Medicare Part D under Bush. When Part D was introduced, there was a lot of angst about even signing up for it, as it might take away Prescription Advantage beneifts. Instead, PA has been re-configured as a wrap around program, so seniors still have full coverage. HOW MUCH WILL THIS COST? How much MORE in decades to come? and yet, in less than 10 years, it has become an untouchable sacred cow. The Mass. state budget is genuinely hovering around 50% for health related entitlement programs with no end in sight - for ALL state monies - which is why we have exploding manholes and collapsing bridges.

Also - I wish to register my continuing objection to using the words health CARE and health INSURANCE interchangeably. We DO have universal CARE now; not pretty, perhaps emergency room or clinic based, but care nonetheless. We do NOT have universal INSURANCE yet, and I am not convinced that government is the right delivery system for that. We DO have almost universal coverage for those over 65, and I would look at THAT as the model if we expand, not the plush Senate health insurance programs that activists point to. Virtually every person in Medicare buys a supplement to cover holes in the government system. I am not convinced that universal insurance would work any differently, except we'd pay twice - in taxes and in premiums.

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