Posts filed under ‘Health Care Reform’
“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.
Mandating Health Insurance – Hmm: Sounds Good.
The President favors requiring everyone to have health insurance coverage (Washington Post, p. A4, June 4, 2009). That’s a good idea, but how do you get there from here? The conversation is confusing. Employer mandates, individual mandates, subsidies for employers, subsidies for the poor, healthcare exchanges, go figure! What about the CHIP program? And, where will Medicare and Medicaid be in the mix? With employer-based coverage being in a state of flux and the fragility of our economy, including rampant job loss, relying on employer-based coverage seems risky, to say the least. Then there are the many issues of deciding the nature and scope of services and benefits to include in mandatory health insurance packages and how to make sure that mandatory insurance actually yields health care.
The solution: A strong public program, available to everyone, that guarantees health care coverage for all. Hmm, maybe we can get there from here.
The Public is Ahead of the Politicians
Why are our representatives in Washington so afraid of government involvement in health care that even a public plan option is being handled gingerly? A CNN/Opinion Poll issued May 29, 2009 found that an overwhelming 63 % of those polled favored an increase in the federal government’s influence over their own health care plans in an attempt to lower costs and provide coverage to more Americans. The poll indicates a split on increasing taxes to do so. This is all evidence of why a robust public plan option – which will save tax dollars, compared with private options – must be part of any health care reform solution. Are you listening Congress?
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?
The Cart Before The Horse?
It’s time to change the conversation about health care reform from protecting private insurance companies to protecting the American people. Senator Charles Schumer is quoted in today’s New York Times as saying any public plan included in health care reform must comply with private insurance requirements.
Senator Schumer has it backwards. Since when is health care for Americans about making things work for private, profit-making insurance companies? Isn’t the moral imperative to provide for the medical needs of American citizens? If we are looking to equalize public and private offerings, how about eliminating profits for private companies, requiring standardized benefits, notices, appeal rights, and full due process, with full and complete access by the public to all their records – as would be the case with a public plan.
Public Support for a Public Plan Option
The Kaiser Family Foundation released its April polling information last week and guess what? The most popular reform option was to expand Medicare to the uninsured aged 55 – 64. That reform is strongly favored by 53%, and another 26% of those polled say they somewhat favor such an expansion.
A public plan option is favored by 67% of those polled, though only 34% are strongly in favor of a public plan. Additionally, 57% of people questioned thought having a public plan option would cause the private plans to do a better job.
Do we think that Congress will listen?
From the Desk of Judith Stein….
Update: Real reform still possible
Apparently the President will support use of the Senate “Reconciliation” process to move health care reform if the super-majority of 60 votes needed to avoid a filibuster can’t be garnered to pass a good plan. We heard this last week from a senior senator – he hoped a bipartisan vote would be possible, but indicated that certain principles need to be met by any health care bill, and that Reconciliation would be considered if those principles would otherwise be sacrificed. Amen to that.
Let’s not accept “something’s better than nothing” again! That mantra helped pass the 2003 law that gave us private Medicare Advantage, Part D, and windfalls for corporations – at the expense of Medicare participants and taxpayers. Been there, done that. This time we need a good plan with a solid public option that puts people above profits.
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April 24th
CMA Health Policy Consultants’ contacts in DC indicate that a public option in health care reform is in jeopardy. Is it possible that after all the problems Medicare has had with private plans, and the plans’ exorbitant additional costs, that we will actually let corporate greed trump the interests of sick people and taxpayers once again?
CMA Health Policy Blog 