Through the participation of individuals, employers, government, and health care providers, California could achieve near-universal coverage in two years, despite challenges that dwarf those facing Massachusetts and many other states, George Halvorson, Kaiser Foundation Health Plan president and CEO, and coauthors say in an article published Dec. 12 on the Health Affairs Web site. Halvorson and fellow Kaiser executives Steve Zatkin and Jay Crosson lay out a coverage expansion plan that combines an individual mandate administered through the state income tax system with new premium subsidies for low-income Californians. The proposal's release was praised by the incoming chairman of the House Ways and Means Health Subcommittee, Rep. Pete Stark (D-CA), in a press release. http://www.house.gov/stark/news/109th/pressreleases/20061213_kaiser.htm

The principle behind health savings accounts, that out-of-pocket payment restrains excess health spending, is sound, but the $5,450 maximum deductible for HSA-eligible insurance policies leaves too much spending unaffected, Martin Feldstein says in the Nov/Dec issue of Health Affairs. A better design, he argues, would require substantial coinsurance up to a higher amount, such as $10,900, or twice the current maximum deductible. "Although there must be a lower limit on the coinsurance rate to make sure that it has a favorable incentive effect, a 100 percent coinsurance rate (that is, a deductible) on a low amount is certainly wrong," Feldstein states. The Harvard economist also suggests allowing hospitals to have easy access to the HSA balances of people who have not paid for treatment within some period, such as three months, after the time of care.

All readers are welcome to comment on Health Affairs' new blog. Recent posts include:

• Health Affairs Deputy Editor Rob Cunningham surveys the health care issues likely to command attention when the new Congress convenes in January. http://healthaffairs.org/blog/2006/12/13/medicare-under-the-gun-medicare-trigger-looms-in-07/
  
  
• A student leader advocates greater efforts by universities to assure global access to medications on which they hold patents. http://healthaffairs.org/blog/2006/12/11/global-health-a-call-for-global-acess-to-university-developed-drugs/
  
  
• Former Blue Cross/Blue Shield executive Steven Sieverts writes on insurance for developing nations. http://healthaffairs.org/blog/2006/12/04/global-health-private-insurance-for-developing-countries/
  
  
• Health Affairs Deputy Editor Rob Cunningham writes about House Ways and Means Committee Chair Bill Thomas' (R-CA) last hearing, devoted to Medicare payment for end-stage renal disease. http://healthaffairs.org/blog/2006/12/06/pharma-chairman%e2%80%99s-parting-salvo-on-esrd/