While people who work with these kinds of issues can present their best guesses, they cannot actually provide proof that the Obama Administration's health care plan is good or bad, or how much it will cost. The 'if only' propositions that are in much of the plan tend to make statisticians and fact-checkers nervous, simply because of the nature of these kinds of propositions -- they rely on the best-case scenario (D'Angelo & Winfree, 2008). What would happen if the best-case scenario does not work out is something that cannot easily be answered, and that is what has people the most concerned. Everything is fine if things operate smoothly, but a simple problem could end up costing millions of dollars and/or leaving a lot of people without insurance (D'Angelo & Winfree, 2008). There is also the concern regarding government control, because many people are already voicing their concerns about the government attempting to interfere too much in their lives. If they are worried about that now, how much more will they be worried if this health plan and mandatory health insurance requirements are put into place? That is something else that the experts cannot yet answer. It remains to be seen as the potential of this plan comes to light and as the Obama Administration moves forward with it.

Highlighted Paragraph Summary

According to the President, people cannot afford health insurance, and that is the chief reason why they do not have it. The campaign made a promise that an average family would be able to lower their insurance premiums by around $2,500. They did this in order to make their plan seem real to people, so they would clearly understand what Obama was offering (Sack, 2008). The best-guess estimates of the advisors were used to come up with that number, as that would be the amount they would assume a family would save if the plan that Obama proposed was working exactly the way that it should. The Lewin Group, however, analyzed the Obama plan and stated that the actual savings to a family would only be $426 -- a significant difference.

Working Outline

I. Introduction

Thesis -- the Obama health care plan is confusing to a lot of people, and there are many conflicting opinions about its cost and perceived effectiveness; these must be sorted out so that the country can make an informed decision regarding the value of this plan for the country.

II. Healthcare in America

A. Past Healthcare

B. Current Problems

C. Future Concerns

III. The Obama Health Plan

A. Pros of the Plan

B. Cons of the Plan

C. Public Opinion

IV. Conclusion

Revision Summary

Revision strategies for this paper included doing more research than had been originally planned. There were so many conflicting options and ideas among laypeople, politicians, and companies and organizations that were studying the issue that it became very difficult to separate what was true from what was opinion. Because of that, digging deeper was required and still may be necessary. There are so many elements of the plan -- specific details -- that still are not clear, making it hard to form a solid opinion of the value and worth of the health care plan proposed by the Obama Administration.

Simplifying what was studied and addressed also became necessary, because talking about the plan in too much detail does not clarify anything. It only becomes more confusing because there is so much that can be looked at. For the length of the paper it made much more sense to focus on the biggest of the basics such as the cost, the implementation, and whether the public thinks that the plan is a good idea. With that in mind, reducing the outline to a more basic form and focusing on both sides of the health plan -- pros and cons based on what is currently verifiable and accurate -- seemed to be the most logical and rational solution.

Article Copy

http://www.heritage.org/Research/Healthcare/wm2114.cfm

October 24, 2008

The Obama Health Care Plan: A Closer Look at Cost and Coverage

by Greg D'Angelo and Paul L. Winfree

WebMemo #2114

Presidential candidate Senator Barack Obama (D-IL) has put forth an ambitious health care plan.[1] the plan proposes:

Expanding eligibility for existing public programs, including both Medicaid and the State Children's Health Insurance Program (SCHIP);

Creating a National Health Insurance Exchange to serve as a federal regulator of private insurance plans that would compete alongside a new National Health Plan;

Providing income-related subsidies for those without employer-sponsored health insurance while mandating that children have coverage; and Requiring that medium and large employers provide coverage or pay a tax, while extending tax credits to small businesses and creating a government reinsurance...

Nonetheless, several organizations have done so, using a variety of assumptions and methodologies.[2] Most notable are the Lewin Group,[3] Health Systems Innovations Network,[4] and the Urban Institute-Brookings Institution Tax Policy Center.[5]
The best independent research shows that the Obama plan would cover roughly half of the 45 million uninsured through an expansion of public coverage; rely on soft methods of cost-savings; and require significant increases in federal expenditures.

Coverage. According to the Lewin Group, the Obama plan would reduce the number of uninsured by 26.6 million in 2010 if fully implemented in that year. The plan would also bring about significant shifts in sources of coverage. While 21.6 million people would lose their private health insurance, 48.3 million people are projected to obtain public coverage through Medicaid, SCHIP, or the new National Plan. Private employer-sponsored coverage would decline by 13.9 million, and private non-group coverage would decline by 7.7 million. Meanwhile, 18.6 million employees would buy into the new public plan through their workplace (as their employers switched to this plan from private coverage), 13.1 million individuals would buy into the public plan in the non-group market, and 16.6 million individuals would become newly enrolled in Medicaid or SCHIP. Therefore, the expansion of coverage under the Obama plan would be driven by enrollment in public coverage. This would entail a crowd-out of existing private non-group and private employer-sponsored insurance.

Estimates of sources of coverage, however, are sensitive to assumptions about the level at which provider reimbursement is set for the National Plan. The figures above are based on the assumption that the National Plan would reimburse providers at a level halfway between private market rates and the lower rates set by Medicare. In an alternative scenario modeled by Lewin, reimbursement was reduced to Medicare payment levels. Enrollment in the National Plan reached as much as 42.9 million, contributing to a 32-million-person decrease in private health insurance and a 60.1-million-person increase in public coverage. While sources of coverage would change significantly, there would not be a significant change in the net reduction of the uninsured.[6]

Lewin applied a type of model known as a micro-simulation.[7] Health Systems Innovations Network (HSI) conducted an analysis (funded by the McCain campaign) also using this type of approach.[8] it found that the plan would reduce the uninsured by 25.5 million. It also found that 24.6 million people would enroll in the new public plan through employers or in the non-group market. However, the HSI study did not look at the proposed expansions of Medicaid and SCHIP that would further increase enrollment in public coverage.

In contrast, the Tax Policy Center (TPC) applied a different type of model known as an elasticity-based approach.[9] the TPC estimated the Obama plan would reduce the number of uninsured by 18.4 million in 2009. In that year, 4.3 million people would gain employer sponsored insurance, 5.8 million would obtain non-group coverage, and 8.3 million would enroll in public coverage. The TPC did not take into account the differences in provider reimbursement between the National Plan and private insurance.[10] Moreover, the results are somewhat confusing because it is impossible to determine enrollment in the National Plan.

Cost. According to the Lewin Group, health care system-wide savings over the 2010-19 period would be about $571.6 billion. Since the plan does not fundamentally change incentive structures in the health care sector,[11] most of its anticipated savings come from various delivery system improvements common to Obama's and McCain's plans, ranging from health information technology to disease management. The effectiveness of these initiatives assumes major behavioral changes. As Professor Mark Pauly, a prominent health care economist at the University of Pennsylvania, explains:

The main problem is that these [popular, common methods] are "if only' savings, which can be achieved "if only' certain events would occur, such as physicians' being willing to adopt health it, consumers being willing to accept changes in diet and exercise. & #8230; There is little evidence that there are known methods to cause the "if only' behavior to occur, and to occur quickly on a large enough scale to matter.[12]

The efficacy of these "if only' savings has been seriously questioned by the Congressional Budget Office (CBO). The CBO has reported that evidence of disease management,[13] comparative effectiveness,[14] health information…