Health Care Reform Essay
Columbia University professor Michael Sparer outlined some possibilities for health care reform in the current issue of the New England Journal of Medicine. He does mention physician assistants and nurse practitioners.
The 2008 presidential election has rekindled long-simmering hopes for comprehensive health care reform. The policy debate includes references to new government programs (perhaps a federal program for the uninsured to buy into) and vague formulas for cost containment (usually involving overly optimistic assessments of savings to be generated by using health information technology). Ironically, however, the debate generally ignores what I see as the most plausible path toward universal coverage: first, expanding Medicaid to cover the largest portion of the uninsured, Americans with incomes below 350% of the federal poverty level (around $62,000 for a family of three); and second, requiring everyone to carry health insurance and allowing people whose incomes are too high for automatic coverage to buy into Medicaid.
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It will be interesting to see how quickly the health care reform debate moves this year with so many critical issues demanding the immediate attention of the Obama administration.
Many economists expect unemployment to increase significantly in 2009, which means that millions of people—and their families—will lose their employer-sponsored health care altogether or have to find a way to make costly COBRA payments to retain their insurance coverage.
Most health care providers won't have their jobs threatened by the ongoing recession, but many of their patients are going to be struggling.