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From the Desk of Judith Stein
Health Care Reform: If It’s Good it Won’t Be Easy
I have represented Medicare beneficiaries throughout Connecticut and the country for over 30 years. While there are surely gaps in Medicare coverage, and recent privatization efforts have threatened Medicare’s stability, Medicare has provided basic health insurance coverage, peace of mind, and enhanced economic security to hundreds of millions of older and disabled people, and their families. Finally, as a result of Senator Dodd’s leadership and the Senate HELP Committee’s bill, there is hope that younger uninsured people and their families will be benefited as older and disabled people have been under Medicare. The Senate HELP Committee bill, like all legislation, is a compromise; it is not perfect, but it is well worth supporting. I do so enthusiastically from three vantage points:
- As an advocate for fair access to health care and Medicare, and something of a Medicare historian, I particularly praise the Senate bill’s inclusion of mandated core benefits and a public health insurance option. Medicare teaches that this is the only way to truly provide fair access to comprehensible, secure, affordable health insurance and care. Anyone who truly knows Medicare and who looks objectively at the value and costs of the traditional program versus the private Medicare plans knows this is true.
- As a cancer survivor, I applaud this bill as it will bring access to health insurance and coverage to many who now go without by finally prohibiting insurance discrimination based on pre-existing conditions.
- As a small business “owner” (founder and executive director of a non-profit organization with 30 employees), I am grateful for the relief that this bill promises to employers, like my organization, that provide employee health insurance coverage. The cost of our good, but not “Cadillac” coverage, is a terrible strain on our budget and limits our ability to hire.
Thanks to the President, Senator Dodd and those on the Senate HELP Committee for pushing forward to provide health care coverage, and with it, access to care. Please – keep it up. Bring your Senate Finance Committee and House colleagues along. This is not easy, but good things rarely are.
We need health care reform!
Is Senator Lieberman Kidding?
I am appalled that Senator Lieberman has announced his opposition to a public plan in health care reform. Can he really believe a PUBLIC option can’t be afforded after our experience with Medicare and Medicare private plans! As Medicare has shown, private plans are what we can’t afford. Study after study shows that Medicare, our only experience with a national health insurance, is spending about 14% more in private plans than it would pay for the same care in the traditional, public Medicare program. The extra payments to private Medicare plans equal about $15 billion a year! Come on – if we really are worrying about cost, a public plan is what we CAN afford. It’s private insurance that’s killing Medicare and that will bankrupt health care “reform”.
Mr. President: Listen to Your Doctor!
The (President’s) doctor orders Medicare for all. He’s right. If conventional wisdom is correct, and a single payer system is not “on the table,” surely the President and reform leaders must at least insist on a public health insurance option.
If the goal of health care reform is to provide coverage for all as cost-effectively as possible, a public health insurance plan MUST be included in any health care reform package. We can’t afford to be scared again by dire warnings about Big Government. Big Insurance costs a lot more than a public program and it helps people get health coverage a lot less. Ask anyone who really knows about the public Medicare program and private Medicare plans.
Support a true public health insurance option! It’s best for people who need health care and most cost-effective for taxpayers. Isn’t that what the President and his doctor ordered?
From the Desk of Judith Stein
A True Public Plan: The Only Affordable Way to Provide Health
Care Reform
Have you read Paul Krugman in today’s NY Times? As he asks, what is health care reform for, people or insurance companies? We were already bamboozled into giving Medicare to the insurance and pharmaceutical industries in 2003. To the tune of about $15 billion a year! Are we really going to be scared into doing that again? Write your Congress people. Write the President. Tell them to support a TRUE public health plan option. And tell your friends to tell their congresspeople and president too!
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June 22, 2009
OP-ED COLUMNIST
Health Care Showdown
By PAUL KRUGMAN
America’s political scene has changed immensely since the last time a Democratic president tried to reform health care. So has the health care picture: with costs soaring and insurance dwindling, nobody can now say with a straight face that the U.S. health care system is O.K. And if surveys like the New York Times/CBS News poll released last weekend are any indication, voters are ready for major change.
The question now is whether we will nonetheless fail to get that change, because a handful of Democratic senators are still determined to party like it’s 1993.
And yes, I mean Democratic senators. The Republicans, with a few possible exceptions, have decided to do all they can to make the Obama administration a failure. Their role in the health care debate is purely that of spoilers who keep shouting the old slogans — Government-run health care! Socialism! Europe! — hoping that someone still cares.
The polls suggest that hardly anyone does. Voters, it seems, strongly favor a universal guarantee of coverage, and they mostly accept the idea that higher taxes may be needed to achieve that guarantee. What’s more, they overwhelmingly favor precisely the feature of Democratic plans that Republicans denounce most fiercely as “socialized medicine” — the creation of a public health insurance option that competes with private insurers.
Or to put it another way, in effect voters support the health care plan jointly released by three House committees last week, which relies on a combination of subsidies and regulation to achieve universal coverage, and introduces a public plan to compete with insurers and hold down costs.
Yet it remains all too possible that health care reform will fail, as it has so many times before.
I’m not that worried about the issue of costs. Yes, the Congressional Budget Office’s preliminary cost estimates for Senate plans were higher than expected, and caused considerable consternation last week. But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts. Furthermore, Democratic leaders know that they have to pass a health care bill for the sake of their own survival. One way or another, the numbers will be brought in line.
The real risk is that health care reform will be undermined by “centrist” Democratic senators who either prevent the passage of a bill or insist on watering down key elements of reform. I use scare quotes around “centrist,” by the way, because if the center means the position held by most Americans, the self-proclaimed centrists are in fact way out in right field.
What the balking Democrats seem most determined to do is to kill the public option, either by eliminating it or by carrying out a bait-and-switch, replacing a true public option with something meaningless. For the record, neither regional health cooperatives nor state-level public plans, both of which have been proposed as alternatives, would have the financial stability and bargaining power needed to bring down health care costs.
Whatever may be motivating these Democrats, they don’t seem able to explain their reasons in public.
Thus Senator Ben Nelson of Nebraska initially declared that the public option — which, remember, has overwhelming popular support — was a “deal-breaker.” Why? Because he didn’t think private insurers could compete: “At the end of the day, the public plan wins the day.” Um, isn’t the purpose of health care reform to protect American citizens, not insurance companies?
Mr. Nelson softened his stand after reform advocates began a public campaign targeting him for his position on the public option.
And Senator Kent Conrad of North Dakota offers a perfectly circular argument: we can’t have the public option, because if we do, health care reform won’t get the votes of senators like him. “In a 60-vote environment,” he says (implicitly rejecting the idea, embraced by President Obama, of bypassing the filibuster if necessary), “you’ve got to attract some Republicans as well as holding virtually all the Democrats together, and that, I don’t believe, is possible with a pure public option.”
Honestly, I don’t know what these Democrats are trying to achieve. Yes, some of the balking senators receive large campaign contributions from the medical-industrial complex — but who in politics doesn’t? If I had to guess, I’d say that what’s really going on is that relatively conservative Democrats still cling to the old dream of becoming kingmakers, of recreating the bipartisan center that used to run America.
But this fantasy can’t be allowed to stand in the way of giving America the health care reform it needs. This time, the alleged center must not hold.
“Venting” About Single Payer Health Care
Dr. Walter Tsou, a former Commissioner of Health in Philadelphia and a public health physician, eloquently testified before Congress on Wednesday, June 10, 2009 about why a single payer health plan is necessary. Although the Washington Post saw fit to characterize his and other speakers’ thoughtful and reasonable opinions as “venting”, in fact Dr. Tsou made many excellent points. Among them were:
- The only affordable means to achieve quality health care for every American is through a “properly financed, single payer national health insurance program”;
- Attempts to reconcile universal coverage with cost control are futile without a single payer plan;
- Cost controls will mean that either taxpayers , physicians, hospitals or the private health insurance industry will have to ‘pay the piper’
- The private health insurance industry, which has dominated health care for the past 50 years in a supposedly competitive marketplace, has proven unable to control costs, even while the quality of health care in the U.S. is “suboptimal” (the federal Agency for Healthcare Research and Quality’s term, not Dr. Tsou’s) and nearly 50 million people are uninsured
- A single payer plan cuts costs by cutting insurance firms’ profits, streamlining the massive administrative apparatus that adds to the costs of hospitals and doctor’s offices, using bulk purchasing, negotiating fee schedules with physicians, and putting hospitals on predictable, global budgets
- By entrusting health care to private health insurers, we have saddled the U.S. with an inefficient and exorbitantly expensive health care system that drives jobs overseas where health benefit costs are low, and discourages entrepreneurs from striking out on their own for fear of losing their health insurance coverage
- The $19 billion dedicated to health information technology is doomed to failure because our health care system will remain too fragmented under any system but a single payer plan.
Medicare is a single payer system. It’s time that an “Improved and Enhanced Medicare for All” be seriously considered and adopted by Congress and President Obama. It is the best solution to our current health care mess.
The complete text of Dr. Tsou’s remarks can be found here.
From the Desk of Judith Stein…
Senator Baucus, chair of the Senate Finance Committee, indicated yesterday that, despite prior comments distancing health reform efforts from a public plan, such a plan would be included in Senate legislation. Thank goodness.
Finally, it appears that legislators are listening to the people – and to experts like Nobel Laureate economist Paul Krugman, who offers two important pieces of advice in today’s New York Times:
“1) Don’t trust the insurance industry.
2) Don’t trust the insurance industry.”
The insurance industry is finally suggesting that they can operate health plans more efficiently and economically. They are even willing to accept more regulation. Why? Because they fear a public health insurance plan.
For an industry that so enthusiastically supported “competition” and “choice” when the Medicare Part D-ebacle was pushed through Congress, they suddenly seem to want to limit choice to only private plans.
To paraphrase Mr. Krugman, how can we expect to fix a broken game if we’re just fielding the same sullied players? Kind of makes you stop and think.
The Indispensible Dozen: What We Need In a Public Health Care Plan
It seems hard to believe to us, but there is actually a debate going on about whether health care reform should include a public plan option – as opposed to only private insurance plans. (Never mind whether health care reform should simply be one public plan, or a choice of public plans!)
We have discussed why a public plan is necessary. The inevitable conclusion is that any reasonable approach to health care reform must include, at the very least, a public option.
But what would a public plan look like? What elements of a public plan are essential? Here are the indispensible dozen elements:
1. Like the long-standing, public Medicare program, the plan should be available to all, throughout the United States, without exclusions for pre-existing medical conditions, and with community rating (the same base premium for all, regardless of age, medical history or other “category” that the person may fit into).
2. The public plan should resemble the traditional, public Medicare program. (Polls show that 80% of Medicare beneficiaries are either “extremely” or “very” satisfied with Medicare.) In designing health care reform policy makers should learn from the successes of traditional Medicare and the costs of privatization.
3. The public plan, as well as any other plans authorized by Congress, should receive additional payments or “risk adjustments” for sicker or more costly patients. This is necessary so no plan ends up being a default for more costly people with the result that it becomes insolvent.
4. The public plan’s benefits should be at least as broad as traditional Medicare, and should be enhanced by adding coverage for mental health, dental services, long term care, vision care and eyeglasses, hearing aides, and increased coverage for preventive services.
5. A greater emphasis should be placed on primary care, especially for manageable chronic conditions. This emphasis should be financially encouraged with incentives to providers and enrollees. Perhaps most importantly, the plans should have a clear rule that care designed to maintain (as well as to “improve”) function or health status is covered.
6. Out-of-pocket expenses should be limited. Public plan premiums (and those of private plans, if they are to be offered) should be affordable, with no co-insurance or deductibles. Although there is a school of thought that requiring patient co-pays makes them better health care consumers, studies show that when cost sharing required, many people cannot afford it and forego necessary medical care or prescription medication. The result: more serious medical conditions and more costly care down the line. (Rosenthal, What Works in Market-Oriented Health Policy, New England Journal of Medicine, May 21, 2009)
7. Subsidies should be provided for lower income persons, based on a sliding scale, which would assist with premium payments. Premium costs should capture regional costs differences, as should subsidies to lower income people.
8. The public plan should have the authority to negotiate prices with health care providers and pharmaceutical companies.
9. Enrollment procedures and time frames in the public plan should be user-friendly. Eligible persons should be able to move freely between whatever plans are offered, particularly when there has been a change in an employer’s health care coverage or a change in the individual’s circumstances.
10. There should be a simple, easy to use appeals process for (public and private) plan participants based on the Medicare appeals process, and assuring that all current due process and appeal protections guaranteed to Medicare beneficiaries are afforded to participants in plans created through health reform, including the public plan and any private plans.
11. The public plan should include financial payments to providers for offering interpreter services and for translation of materials into the major languages of the enrollees whom they serve. Education and training should be offered to providers to assure that treatment and patient education is culturally relevant, in order to assure positive health outcomes and minimize the need for more expensive care down the line.
12. US citizen-children and the parents of those children, if the parents reside in the United States, should be eligible to purchase insurance through the public plan.
These dozen essential elements of health care reform would ensure that enrollees are able to access comprehensive, affordable health care and achieve positive health outcomes at a reasonable cost to society.
Isn’t that what health care and health care reform should be all about?
Private Insurance Interests Trying to Kill Key Plank of Obama Plan
A recent Washington Post article alerted us to TV ads that will be appearing on the airwaves soon. The ads, from the private insurance world, are a scare tactic to drive people off the idea of a public health care plan.
Private Insurers Desperate to Avoid Public Plan
The following is from the National Health Law Program (www.healthlaw.org). It illustrates very clearly that a public option for health care is the most efficient solution to our nation’s health care woes, as evidenced by the insurance industry’s desire to derail such a plan.
We offer the following for the benefit of anyone who might still be even slightly in doubt about the best way to provide people with health coverage that they want and need. Everyone involved in health care reform (and a 2 to 1 majority of the American people, whose opinion will apparently not be terribly involved in health care reform) knows that providing coverage through a public plan is the right answer. This is vividly demonstrated below by the quite remarkable testimony of the insurance industry, and Republican public plan opponents… The former is now begging to be regulated, and promising to abandon some (but of course not all) of its worst current abusive practices, rather than face the specter of a public plan option with which it knows it cannot compete. The private insurance industry’s Republican apologists (here embodied by Sen. Cornyn of Texas), for their part, have suddenly lost their stomach for market competition if one of the options is a plan not premised on maximizing profits (and therefore minimizing those things that eat into profit, like coverage, e.g.). At any rate, the following should brighten the day of all those who have known the right answer all along and watched with dismay as those in Washington engage in their Kabuki theater aimed at avoiding the obvious.
Cong Daily 5.6.09 AM
HEALTH: AHIP PLEADS ITS CASE: REGULATE US
By Anna Edney
In a rare sight on Capitol Hill for any industry, health insurers practically begged senators Tuesday to regulate their livelihood rather than subject them to the fierce, and potentially lethal, competition that would ensue if lawmakers unleash a government-run public insurance option on them.
“We accept the premise that the system is not working today and needs to be reformed and, in fact, we need very clear, specific government regulation,” Karen Ignagni, president of America’s Health Insurance Plans said.
AHIP also said insurers would stop discriminating based on gender, which typically leaves women paying more than men.
AHIP has suggested insurers are willing to drop conditions for insurance
coverage and variations in premium costs depending on how sick a person is.
Ignagni spoke at a roundtable discussion with the Senate Finance Committee and other stakeholders. She elaborated after the event that she envisions the government setting a minimum health benefit package and enforcing the limits through penalties she said AHIP would help design. She admits the request is unusual.
“It’s radical for an industry working in a market to say ‘Renovate the
rules. Here’s the road map,'” Ignagni said.
Much of Tuesday’s three-hour discussion focused on the public option. It’s a vexing topic for Finance Chairman Max Baucus, who is trying to find compromise for some Democrats who insist on one and Republicans who vehemently object. Showing how the rhetorical flourishes will be shaped, a few Democrats Tuesday renamed the public option the “consumer-oriented health” plan, while Sen. John Cornyn, R-Texas, dubbed it the “Washington-directed unfair competition” plan.
Democrats and many patient and consumer groups argue a public option will increase competition and hold private insurance companies accountable, while Republicans and insurers maintain a public option would drive insurance companies out of business.
Ignagni contends the public option idea stems from thinking formed before insurers came to the negotiating table. Instead, she says, healthcare coverage can expand and insurance companies can be held more accountable with changes that negate the need for a public option.
“What we are proposing is a wholesale change and a complete overhaul of existing regulation, so it would be set out at the federal level, clearly, transparently hitting the mark with respect to: No one falls through the cracks; no one is discriminated against because of pre-existing condition; no one has to pay according to health status and there would not be gender differentiation,” Ignagni said. “That essentially is the thrust of what folks have quite correctly talked about needs to be done.”
Baucus posed the critical question of who should be responsible for coming up with a minimum health benefit package. “There’s those over the last couple, three years that have suggested a medical board that would insulate members of Congress from the onslaught of every group under the sun that wants to be covered,” Baucus said. “Others say, ‘No, no, no, no, no that’s too much big government. That’s socialism.'”
Even though they could not agree on a public plan, participants at the
roundtable agreed for the most part that Congress should not be involved in making such policy decisions.
“Anyone other than the people here, because I think it is an incredibly
important decision and politics shouldn’t play a role,” Andy Stern,
president of the Service Employees International Union, said.
Ron Pollack, executive director of FamiliesUSA, echoed Stern but suggested Congress take an active role in setting limits on out-of-pocket costs to keep health coverage affordable.
CMA Health Policy Blog 