By the way, I’m not the only one who’s giving this some thought of late: both Jason Shafrin at the Healthcare Economist and Amy Tenderich at Diabetes Mine have some intriguing ideas on the subject, as well….

Disagreeing with Bruno: Actually, the “minimum package” in Brazil is quite fragmented – the insurance companies (well, here it works a little bit more like HMOs) can offer “segmented” packages. For an instance, the ambulatory plan covers only exams and physician consults; the hospital plan covers cirurgical procedures, hospital costs, cirurgic materials, etc. It is possible for the HMOs to offer, in a health plan, a combination of segments, like ambulatory plus hospital segmentation.

In the “cons” you poses the following and one of the most important questions: who decides for the procedures/benefits of the package? In Brazil, there is a Regulatory and Executive Agency specific for such task: the National Agency of Supplementary Health. It is the governmental agency responsible fot, between other questions, deciding who gets what.
As you pointed correctly, it is subject to lobby pressure from HMOs, health insuarance companies, consumers associations and providers organizations. Too many interest groups interested!

You may count on me as a regular visitor of this blog.

Best regards.

Second, I think there is a mistake in the post when it said that the minimum benefit package would attenuate adverse selection. Probably, the average premium would rise and this would worsen the problem.

My country (Brazil) adopts since 1999 minimum package of benefits (the ICD-10) and there are evidences that the probability that older individuals are demanding more health insurance than before has risen (the inverse being truth for younger individuals).

This we know: biologic systems are complex, hence medicine is complex. Biology is analog not digital, hence what is best is not always clear. For example, there is no one precise total hemoglobin value for everyone, nor is there one precise normal value of estrogen, testosterone and every other hormone in the body. As a result, there are no singular precise choices that can be applied to every incident of human pathology whether treating an ear ache or heart attack. Sure, some practices are better than others, and medicine is working hard on identifying those, but it’s not a simple task and we can’t afford mistakes.

As hard as it might seem to many of us, not everyone values good health equally. Some smoke, to many over eat or over drink, or both, it’s just that way. What drives the cost of health care is as much behavior as it is anything else.

What should bother anyone in favor of single payer national health is the resulting bureaucracy that will lie between the patient with a problem, and it’s solution. Canada works because it has a “relief valve” the entire width of the northern border of the US.

We ought focus on how to improve efficiency of those providing health care, and less about the book keeping, or worst yet, creating one large national labor union.

Tom