Edwards on health care

I don’t envy any pol who has to speak after Barack Obama, even if you are as accomplished a speaker as John Edwards. Despite the difficulty, Edwards acquitted himself admirably.
Now onto the topic we’re all focused on; where Edwards is on health care.

For the candidate with arguably the most comprehensive and detailed position on health care, Edwards didn’t spend a lot of podium time focusing on the issue. He waited until his closing comments to even mention the topic, starting by focusing on the need for universal coverage.
Edward’s “threshold test” of health care reform is “does it provide universal coverage?” Encouragingly, Edwards noted that this will cost money, a total of $90 to $120 billion a year, which he will fund by not renewing the Bush tax cuts. His platform includes a ban on insurers limiting coverage due to pre-existing conditions, mental health parity, coverage for long term and preventive care, and portability.
His plan is employer-based, requires employers offer health insurance to all employees, but does provide for a governmental role in maintaining Medicare and acting as an insurer for low-income and unemployed families and individuals. This last leverages existing Medicaid and SCHIP programs.
Community rating is also mandated, with specific prohibitions against medical underwriting, the use of age bands and any coverage exclusions. Similar to some of the other candidates, Edwards will create health insurance purchasing groups, in his case these will be regional; include a Medicare-for-all option,
On the cost and quality side, his plan relies on reducing administrative expense (seeing a pattern here?) through improved record keeping and aggressive development and dissemination of evidence-based medical guidelines. While other candidates echo the evidence-based mantra, Edwards’ description of the role they play appears more substantive and reflects deeper thinking about and perhaps a better understanding of health care.
I also believe that by eliminating insurer’s ability to risk select, community rating and universal coverage will force insurance companies to compete on the basis of how well they can manage care and reduce cost.
This makes a world of sense. It’s a little lonely here in single-payer land, but it is gratifying to see that among Obama, Edwards and Richardson, not a one is stumping for single-payer.
The bone I have to pick is Edwards’ reliance on employers as the primary source of health insurance. We have to decouple employment and health insurance, to free employers from some of the burden of providing this outrageously expensive “benefit” and to force insurers to be responsive to their real customer – the insured. As it is now, insurers worry a whole lot more about what employers think than about the people with ID cards in their wallets.