Posts filed under ‘Public vs. Private Health Coverage’
Medicare, We Hardly Know Ya
44 years ago Medicare was enacted into law. All of today’s dire warnings about a public health option – socialism and government barring the doctor’s door – were made in opposition to Medicare. Despite such opposition from “conservative,” leaders, including Senator Bob Dole, Medicare passed.
Before Medicare, 50% of everyone 65 or older had NO health insurance. Now, as a result of Medicare, almost all older people are insured. Medicare, which is national, government-run health insurance, succeeded in insuring older people where private insurance failed. And, until the Bush Administration privatized Medicare with the extraordinarily subsidized private “Medicare Advantage” and Part D plans, Medicare was remarkably cost-effective too. It’s private Medicare, not the traditional, public program, that’s bleeding taxpayers of billions of dollars.
Medicare has been a success, fiscally and morally. It took on the job of insuring health coverage and care to people that private insurance had abandoned. Since 2003, on the other hand, private Medicare plans have cost us all tens of billions of dollars that went to support the private insurance industry, not to providing health care. In addition, private Medicare plans have too often engaged in marketing abuses and restrictive coverage practices.
As Paul Krugman recognizes in today’s New York Times, people with Medicare love it. They do not want government to fool around with the traditional program. Ironically, these are sometimes the same people who worry that a public health care option will cause long waits for health care and government invasions into their private medical decisions. They, and their family members, (which accounts for pretty much all of us), forget that the traditional Medicare program is a public health insurance option.
Hello, America, meet Medicare: Our 44 year-old public health insurance option that provides care to all its enrollees, anywhere in the country, and that has provided health and economic security for millions of older people, people with disabilities, and their families.
Happy anniversary, Medicare. Thank you for showing us what a true public insurance program can offer.
There’s a Way to Pay For Health Care Reform – If There’s The Will
Congress should heed a new report from the Urban Institue if it is truly concerned about cost containment and the best way to pay for health care reform. The Insitute recommends some adjustments to the way we deliver health care – increasing care coordination, improving chronic care and prevention, advancing electroninc medical records – and adjusting taxes.
Not surprisingly, the report also concludes that a public option must be part of the mix if cost is really a concern. In fact, the researchers found that including a public plan option in health reform would save between $224 to $400 billion.
Once again, an independent study concludes that there IS a way to afford to provide health care for all Americans – if there’s the will. Congress: Read the report – and find the will.
We need health care reform that is best for beneficiaries and most cost-effective for taxpayers. We need a public option!
Yes, Virginia, A Public Health Insurance Option Will Save Money and Provide Access To Good Care
Once again, probing, independent minds have concluded that a public health option will save money and provide stable access to health care. A new Commonwealth Fund report finds “A public insurance plan can help drive new efficiencies in the system that will produce large cost reductions. Without a public plan, much of those potential savings will be lost,”
With a public option and a standard set of benefits across all private and public plans, everyone will be better able to access coverage they can understand, at a price taxpayers can afford.
We get it. We need health care reform. We need a public option. We don’t believe in fairy tales. Tell Congress!
A Fourth of July Reflection on the Health Reform Debate
“Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”
President Obama might have spoken those words in recent weeks. Instead, President Truman spoke them over 65 years ago. With nearly 47 million Americans uninsured and millions more underinsured, most Americans are just one pink slip or accident away from financial disaster. The writing is on the wall, and the environment could not be more ready for health care reform. Already this summer, the Congress has produced three different reform proposals:
- The Senate Health, Education, Labor and Pensions (HELP) Committee released Sen. Kennedy’s (D-MA) draft proposal the “Affordable Health Choices Act” on June 9th. The “Affordable Health Choices Act” attempts to improve access to coverage by regulating insurers. The proposal expands Medicaid (to include families who earn up to 150% of the Federal Poverty Level) and SCHIP. The proposal is built upon establishing state-sponsored insurance Gateways (or exchanges) to help Americans find affordable coverage. The current proposal would provide subsidies for buying health insurance through plans inside the Gateways to families with annual incomes as high as five times the poverty level. Senator Dodd (D-CT) announced on July 2nd that the HELP Committee bill will include a strong, national, public health plan option.
- The House has also released a draft version of a Health Reform bill with their Tri-Committee Proposal. The current proposal would set up a new Health Insurance Exchange which would allow individuals and small employers to shop among private and public plans. The proposal also provides sliding scale affordability credits, expands Medicaid (to those earning 133% of the Federal Poverty Level) and caps out-of-pocket expenses. Individuals will be responsible for having health insurance coverage, and employers will have the option of providing health insurance coverage for their workers or contributing funds on their behalf. Small businesses, with payrolls less than $250,000 per year, will be exempt from the employer responsibility requirement.
- The Senate finance committee, chaired by Sen. Max Baucus (D-MT), will release its proposal imminently.
Just as we come together to barbecue or watch the fireworks on July 4th, those of us who believe in the promise of health care for all must also come together. This holiday is a time for us to reaffirm our will to fight the cynics who don’t believe in the essential promises of our land of opportunity and to renew the goal of health care for every American. Our representatives need to hear our voices! Please call your representative and message your members to act for this is our time to fight for our ideals. This week Families USA has published a toll free number that can be used to reach members of Congress. On July 7th and 8th you can call 1-866-210-3678 to connect to the Congressional Switchboard to speak to your representative. Help flood the switchboard. Together we can achieve the reform that we are fighting for.
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.
What’s Wrong With This Picture?
Congress Finds Tobacco Causes Serious Illness And Death. New England Journal Of Medicine Finds Health Insurance Industry Has Large Tobacco Stock Holdings.
The Family Smoking Prevention and Tobacco Act (H.R. 1256ENR) passed both houses of Congress and is awaiting the President’s signature. In that bill, Congress made the following findings:
- “Tobacco use is the foremost cause of premature death in America. It causes over 400,000 deaths in the United States each year, and approximately 8,600,000 Americans have chronic illnesses related to smoking.” H.R.1256 ENR §2(13)
- “The use of tobacco products by the Nation’s children is a pediatric disease of considerable proportions that results in new generations of tobacco-dependent children and adults.” H.R.1256 ENR §2(1)
- “A consensus exists that tobacco products are inherently dangerous and cause cancer, heart disease and other serious adverse health effects.” H.R.1256 ENR §2(2)
- “Nicotine is an addictive drug.” H.R.1256ENR §2(3)
- “Tobacco dependence is a chronic disease, one that typically requires repeated interventions to achieve long-term or permanent abstinence.” H.R. 1256 ENR §2(33)
So, why do health insurance companies, the very companies that Congress wants to run health care reform, have major holdings in tobacco companies?
A recent report in a letter to the New England Journal of Medicine (“Insurance-Industry Investments in Tobacco,” N Engl J Med 360:23, June 4, 2009, at 2483-2484) perhaps provides the answer:
“Insurance firms, like any business, are driven by profit and this fact compromises any health care plan that includes them…..Although investing in tobacco while selling life or health insurance may seem self-defeating, insurance firms have figured out ways to profit from both. Insurers exclude smokers from coverage, or more commonly, charge them higher premiums. Insurers profit … twice over.” (Id.)
According to this recent report, U.S. based Prudential Financial (which provides life and long-term disability insurance) owns tobacco holdings of $264.3 million; U.K. based Prudential (which provides health, life and long-term disability insurance) has a stake in tobacco totaling $1.38 billion; Standard Life (which offers health and life insurance) owns nearly $950 million of tobacco stock; Canada based Sun Life, which offers health, life, disability and long term care insurance owns just over $1 billion of tobacco stock. Northwest Mutual and MassMutual (both of which offer life, disability and long-term care insurance) respectively own more than $235 million and $585 million of tobacco stock. (Id.).
As the writers to the New England Journal of Medicine remarked, “[T]hese data are a reminder of the true priority of the insurance industry, which is making money, not ensuring health and well-being.” (Id.)
Are these really the companies we want running our new health care reform program?
“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.
CMA Health Policy Blog 