Category: Public Option

Reforming Health Care – washingtonpost.com

Reforming Health Care – washingtonpost.com:

The WaPo decides a public option is a bizarre fixation…

“Of the many possible issues that could snarl health-care reform, one of the biggest is whether the measure should include a government-run health plan to compete with private insurers. The public plan has become an unfortunate litmus test for both sides. The opposition to a public plan option is understandable; conservatives, health insurers, health-care providers and others see it as a slippery step down the slope to a single-payer system because, they contend, the government’s built-in advantages will allow it to unfairly squash competitors.

“For liberals, labor unions and others pushing to make health care available to all Americans, however, the fixation on a public plan is bizarre and counterproductive. Their position elevates the public plan way out of proportion to its importance in fixing health care. It is entirely possible to imagine effective health-care reform — changes that would expand coverage and help control costs — without a public option.”

The comments excoriate them, for the most part.

AMNews: April 27, 2009. AMA letter backs Obama’s broad principles for health system reform … American Medical News

AMNews: April 27, 2009. AMA letter backs Obama’s broad principles for health system reform … American Medical News:

“But embracing the eight principles does not mean the AMA necessarily backs every idea on health reform that Obama has revealed so far. For instance, the president has called for creating a public health plan option linked with a national health insurance exchange to serve as competition for private plans. In its letter to the White House, the AMA says it supports a health insurance exchange to ensure coverage choice and portability, but it does not weigh in on the public plan option. To move toward universal coverage, Congress should build on the employer-based system and strengthen the safety net provided by publicly financed programs such as Medicare, Medicaid and the Children’s Health Insurance Program, Dr. Nielsen and Dr. Rohack wrote.

“Dr. Nielsen stressed that the organization is mindful of the need to watch the dollar signs as policymakers work toward the goal of universal coverage. ‘It’s very important for us that all Americans have health care coverage that’s affordable. But we do understand that we can’t afford everything for everybody, so we need to have fiscally responsible conversations.’

“The letter proposes expanding on Obama’s principles in a number of ways, including:

  • Reforming and improving the insurance market through the use of modified community rating, guaranteed renewability and fewer benefit mandates.
  • Assisting low-income individuals through premium subsidies and cost-sharing assistance.
  • Promoting medical home models to reduce system fragmentation and improve care coordination.
  • Establishing antitrust reforms that would allow groups of physicians to contract jointly with payers as long as the doctors certify they are collaborating on health information technology and quality improvement initiatives.
  • Easing the effect of liability pressure on the practice of defensive medicine through innovative approaches, such as health courts, early disclosure and compensation programs, and expert witness qualification standards”

The “8 Principles” of Obama are at the end of the article.

I do wonder why the AMA is pushing back on the public option. It seems to me the only chance physicians have of keeping reimbursement rates reasonable because private insurers will do their darndest to NOT wring savings out of the system (except on the provider side!), and so all that money is money not available to providers. One man’s waste is another man’s revenue.

Support Growing for Major Changes to Health-Care System

Support Growing for Major Changes to Health-Care System:

Most notably, the group, known as the Health Reform Dialogue, calls for creating an ‘individual mandate’ that would require every American to have some type of health coverage. Anyone who cannot afford insurance would be eligible for subsidies or expanded government programs such as Medicaid.

‘We should seek to ensure coverage for all,’ the group concluded after six months of private, professionally facilitated negotiations.

The results are noteworthy because it is the first time that such a varied mix of special interests — ‘strange bedfellows,’ in the words of one participant — have coalesced around significant changes to the U.S. health system. The signers include the American Medical Association, the National Federation of Independent Business, two hospital groups, AARP and the liberal
consumer advocacy group Families USA.

‘We’re narrowing the range of disagreement,’ said Karen Davis, president of the Commonwealth Fund, a nonprofit private health-care foundation that was not involved in the effort. It is striking, she observed, that the Health Reform Dialogue and influential lawmakers have all but ruled out the prospect of a European-style single-payer system, opting instead to build on the existing employer-based insurance arrangements.

Equally striking, however, were the fundamental questions left unaddressed by the group of health-care heavyweights.

‘A day late and a dollar short,’ said one participant who spoke on the condition of anonymity so as not to jeopardize continuing participation.

The coalition’s report is silent on whether employers have a responsibility to contribute to the cost of care, and it does not address the idea of creating a government-sponsored insurance program that would be available for anyone having difficulty buying coverage.”

….

“A government-controlled plan available to every American will push 160 million Americans now in private plans into a one-size-fits-all bureaucratic plan,” said Nick Simpson, spokesman for Rep. Roy Blunt (R-Mo.).

I love that last bit by Rep. Blunt. If by push, he means that by being cheaper, more efficient and consumer friendly, public plans would be able to out compete the very inefficient private insurers, then yeah, they’ll be “pushed.”

The Public Option Favored by the Public

Robert Creamer at Huffington Post has a piece about a poll conducted by the Lake Research “found that a whopping 73% of voters want everyone to have a choice of private health insurance or a public health insurance plan while only 15% want everyone to have private insurance. “

Follow the link to read the rest. (I cannot find a link to the actual polling, sorry.)

This post also gives me a chance to link to
THE CASE FOR PUBLIC PLAN CHOICE IN NATIONAL HEALTH REFORM
KEY TO COST CONTROL AND QUALITY COVERAGE
By Jacob S. Hacker, Ph.D.*

From the executive summary:

This policy brief sets out the argument for public plan choice. The core argument is that public insurance has distinct strengths and thus, offered as a choice on a level playing field with private plans, can serve as an important benchmark for private insurance within a reformed health care framework. This is not an argument for a universal Medicare program, but instead for a “hybrid” approach that builds on the best elements of the present system—large group plans in the public and private sectors—while putting in place a new means by which those without access to secure workplace insurance can choose among health plans that provide strong guarantees of quality, affordable coverage. The case made in this brief is that this menu of health plans must include a good public plan modeled after Medicare if the broad goals of reform—universal insurance and improved value—are to be achieved.

National Journal Online — Health Care Experts — The Public Plan: Time Bomb?

National Journal Online — Health Care Experts — The Public Plan: Time Bomb?:

“Can Congress fashion a public health plan option so that it does not blow up health care reform this year?”

I didn’t get invited to leave a response, so here’s mine:

Interesting discussion.

Dr. Nichols wonders if we have examples of regulated private insurers brhaving properly. At the risk of venturing beyond our shores, don’t we have examples in Switzerland, Germany and other Social Health Insurance Model countries? His examples of public plans already alive and well in the US seem like good models to consider.

Ms. Turner and Mr. Goodman seem to be arguing opposite sides of magical market place coin: One laments that privte insurers will never be able to compete with the public option, and the other that the private insurers will eat the public plans’ lunch. It is possible for them to co-exist, again, if one is willing to suspend the idea of American Exceptionalism and benefit from the experiences of other nations. I will venture to say that if Mr. Goodman is correct and the private insurers provide efficiency, quality and win-out, then “Hallelujah!”, and all of us skeptics of the efficiency and value of private insurers will have been proved wrong, will eat crow, and happily allow the private insurers to be our vehicles for value.

I don’t think this will happen, and it seems that Mr. Goodman may be conflating the role of private insurers in their function as Medicare Carriers and ther role as profit making (even when ostensibly “not for profit”) insurers, dominating their regional markets, and squeezing their policy holders and providers alike.

Dr. Reinhardt, of course, always nails things and does again here. I think he may have overlooked another latent demand among physicians and other providers. Depending upon where you practice medicine, Medicare may be your most reliable, hassle free and even, in some markets, your best payer. Private insurers, while paying significantly more in some regions, may cost providers more in time, hassle, staffing costs and the like that their reimbursement warrants.

Ms. Davis also frames the debate well by focusing in on the acknowledged truth that we must pay smarter, not just more and more and more.

Cheers,

A national healthcare reform primer – Los Angeles Times

A national healthcare reform primer – Los Angeles Times

The cost of covering the uninsured ultimately will depend on the number of people included, the specific benefits they receive, and the amount of financial help the taxpayers would provide. The only agreement among economists who study the issue is that the tab would be a big one:* $200 billion to $250 billion a year, says Joe Antos of the conservative American Enterprise Institute.* $150 billion to $175 billion a year, says Len M. Nichols of the liberal New America Foundation.

According to CMS, we spent $2.1 Trillion on all of health care with costs rising rapidly. So even using AEI’s numbers, this only represents a 10% increase to cover all Americans.

Regardless of what happens, will I be able to keep the insurance I have now?

LA Times answers: “Almost certainly” and “Further, most people get their coverage at work, and this would continue.”

Which is too bad. Given the choice between keeping my $15 K a year policy and buying into a public policy (Medicare – like, if not Medicare) at lower cost, with less red tape, no pre-approvals, fighting for benefits and on and on, I believe most would choose the public option after it has shown its stuff. But if a public option is put out there, it allows the transition to begin away from bloated private insurers as they will have to compete with public policies.


If I don’t have health insurance, would I have to buy it if an agreement on reform is reached?

This is the tricky mandate issue. Advocates say you can’t cover everyone unless you make everyone buy a policy.Although nobody from the administration is using the “M” word these days — a mandate would represent a big expansion of government authority — many believe it is the logical way to go. So do Democratic leaders in Congress.Before such a mandate could become law, however, Congress would have to decide the amount of financial subsidies to help people pay for their coverage. Most people without health insurance work full-time and earn less than $30,000 a year. Meanwhile, the average policy for a family of four under job-based coverage cost $12,680 last year, with the employer paying $9,325, according to figures compiled by the Kaiser Family Foundation. Coverage for an individual through work cost $4,704, with the employer paying $3,983.A decision on a mandate would also involve intense negotiations between the government and the insurance industry over the terms and details of coverage.

The industry has indicated it’s willing to deliver “guaranteed issue” (nobody gets turned down) in return for a law requiring mandatory purchase of insurance.The National Assn of Insurance Commissioners has proposed a model act for the states as a way to control costs. It says that the highest rates for any age group should be no more than 400% of the lowest rate charged to any group.

This would be reduced to 300% two years after the law is passed, then to 200% after five years. That would mean a 63-year-old living in San Diego, for example, could not be charged more than double the rate paid by a 25-year-old in Santa Monica.Price differences and subsidies are crucial. It would be meaningless to have the guaranteed right to buy health insurance if you make $30,000 a year, have high blood pressure and diabetes, and a policy would cost you $10,000.

Well explained. I don’t think it is “tricky,” as there must be guaranteed insurance for all and none can be left out or much savings gained by easy access to primary care is lost.

If I have a business, would I have to buy coverage for my workers?

The answer to this question may determine the success or failure of health reform efforts.

I’m a de-linker in the sense I don’t think insurance should be linked to income and, if you like the deep economics of it, ALL benefits are from wages anyway, so if you want to do like Germny and others,you could use a payroll tax specifically for this purpose. This will cause lots of sturm and drang, however.

Would there be some help for older workers who don’t have coverage on the job and can’t afford an individual policy?

Perhaps.

Again, if we don’t get everyone in, it is not very “universal”, is it? I don’t know enough about the mind set of Congress to make a prediction, but how would the people who are just beginnning to enter their health care using years not be central to the solution?

Might there be a public health insurance plan?

This idea, backed by the president, would create for the first time a public insurance plan to compete with the myriad plans offered by private-industry insurers. The plan would be designed to provide a benchmark for quality coverage, with a basic package of comprehensive benefits. The Obama health plan issued during the presidential election campaign envisioned that millions of the 47 million uninsured would move into a public plan.

To quote Helen Hunt in, “As Good As It Gets,” “I hope, I hope, I hope, I hope.”

How can the country pay for a reworking of its health insurance system?

A nice discussion of some potential savings. This will cause a lots of discussion, but I would go back to the top of the article and point out that even the AEI’s estimates (which I admittedly have not read) which I expect are all worst case scenarios, estimates only a 10% or so increase in costs. I happen to be one who believes that the waste in our system is at least 30% and that in perhaps 5 years we will begin to see those savings. But, even if it costs more, it is the right thing to do.

Their bottom line:

If Obama can figure out a way to persuade Congress to expand coverage to millions of uninsured people, while keeping those with coverage happy, it will be a feat of political magic that has eluded presidents for decades.

I agree. It is up to us to make not doing the right thing a very unattractive option.

Cheers,

A Public Health Insurance Plan | OurFuture.org

A Public Health Insurance Plan OurFuture.org:

As the ball rolls along in our debate, one thing that keeps coming up is the idea that everyone must have insurance. Being forced to buy insurance from a private insurer ($15K a year at our house – from a “not-for-profit” !) is obviously not an option for most, especially considering the median family income is only about $60K. Medicare spends anywhere from $6K to $14K per enrollee (65 and over, mind you). So can a public option be the solution?

Here are the key findings of the report, but you can click the link above to get the full report, an executive summary and a PowerPoint show.

The report contains these findings:
• Medicare has controlled health care costs much better than have private health insurers over the last 25 years.
• The private insurance market is highly consolidated and needs competition from a public health insurance plan to lower skyrocketing premiums.
• Administrative costs are dramatically lower under public health insurance plans,
resulting in enormous savings to the system.
• The bargaining power of public health insurance plans significantly reduces provider costs.
• In a head-to-head competition, the public Medicare plan is much better at containing costs than private Medicare Advantage plans.
• Independent analyses show substantial savings can be achieved from a public health insurance plan that competes with private insurance plans.
• Quality and effectiveness innovations occurring under the public Medicare plan show that public health insurance plans have greater potential to drive the quality revolution than do private plans.
• Public health insurance plans increase choice, competition and accountability.