On the stump in Wisconsin today, President Obama insisted that opposition to health care reform was based on fears that government would eventually run the system and reduce patient choice -- and that such a major transformation was not in the cards. "I don't want government to run stuff," he said.
He suggested that a government-administered health care plan would be a last resort for those who couldn't afford or did not want a plan offered by private insurance companies. Whatever plan passes Congress is likely to include a mandate for Americans to purchase health insurance.
For most advocates, the purpose of a public option is to create an "ideal" health insurance plan that can experiment, can decide to pay doctors what it wants, can use what Rep. Henry Waxman has called "creative tension" to compete with private plans, and one that will ultimately serve as a mean toward which all the private plans move. A strong public plan would force private plans to negotiate lower rates with doctors and hospitals, which would reduce health care costs. A "weak" public plan would provide some competitive pressure, but would not be big enough to force the private plans to drastically change their models. Between these two ends, there are many options. Here are six:
2. The Conrad Plan -- would be a series of health insurance cooperatives, administered privately but not for profit. Details remain vague. The federal government would not directly be involved.
3. The Rockefeller Plan -- would be a conventional, government-run plan that pays for itself via premiums and fees.Reimbursement rates would be based on Medicare for two years (at least), which could, in theory, pressure private plans to lower costs. The plan would follow guidelines that a new health care trust would create. This trust would function as a marketplace, giving providers and patients a sense of what other plans are charging and how effective they are. This is the strongest public plan offered so far by Senators.
4. The HELP (Kennedy) Plan -- still in progress, an early version would require providers to participate, would pay them 10% more than Medicare, and would also expand Medicare and S-CHIP.
5. The House Plan: Medicare would be expanded and eligibility would be based on income alone. The government plan would be modeled after Medicare; to get providers on board, there would be some (potentially significant) reimbursement rate adjustments.
6. The Snowe Float: for a few years, the government would offer a conventional, non-competitive plan. If insurance companies failed to reform, to cut costs, to improve quality, a much stronger, competitive plan would be offered. This is what's known as a "trigger" plan.
I don't really see any of these plans as viable solutions to the health care crisis. Supporters claim that a public plan will reimburse providers at lower rates, and so in order to keep premiums as low or close to as low as the public plan and retain membership, private health plans will have to follow suit and lower reimbursements for providers, thus lowering health care costs. But if we are to assume that provider reimbursements will be relatively in-line with what Medicare pays today, then most hospitals in the country will go bankrupt. Providers lose money on Medicare patients and shift those losses in the form of higher reimbursements to private health plans in order to remain solvent.
There are a number of reasons why health care costs are as high as they are, but providers over-pricing their services isn't one of them. Poor public health, lack of coordinated care, supply constrictions, and over-utilization of diagnosis and treatment techniques are just a few of the reasons why costs are so high. Addressing the roots of these costs will help to ensure that all Americans can have access to adequate and affordable health care. The public plan option will only serve to exacerbate the problems that we are facing.
Money for the uninsured should come first from increasing the age of eligibility for Medicare from 65 to 75. When Medicare was established, people's health at age 65 was much worse than it is now. Government-provided medical care should no longer be offered to that age group. This would keep older people in the work force longer, which would have countless benefits. Politicians are too concerned about their jobs to be willing to do this. AARP lies in its paper every month to members, saying that better healthcare is coming for less money.
Medicare eligibility should be based on income, as the House Plan proposes. It does not make sense to put someone on the dole because they are of a certain age, even if they have plenty of money to buy private insurance.
An enormous portion of the healthcare dollar is spent in the last few weeks of life. Sometimes this is reasonable, often not. Physicians (I am one of them) should talk to their patients about the inevitable, and discourage them from enormous procedures and treatments that will provide them with very little more time to be alive. Death is inevitable. All of us die. The physician's word carries a great deal of weight. However, the entire medical culture needs to embrace the inevitability of death, help patients to be ready for it, rather than to fight it off till the last second. This is happening now, with widespread acceptance of palliative medicine and advanced directives. Education of physicians must move eagerly in this direction.
Services provided by the government should be only the most essential. Think about providing another essential via a government program, for example, housing. How much of a house should taxpayers provide to a poor person? If we've decided that there is a right to healthcare, we must decide how much care that right provides. Taxpayers cannot afford to give people mansions, let alone full service medical plans.
Here's a hard one: there should not be price controls on medical care. If there are, providers will refuse to take patients under government plans. The government cannot force providers to accept patients, even though they say they can. Providers can close their practices entirely. They have the right to fire patients, for any reason. That right cannot be taken away, since a provider can and will say that she or he is incapable of providing care to that patient. And if the government forces providers to accept patients that don't pay, providers will go out of business. It happens all the time. You can't prosecute someone for going out of business. Once providers go out of business or leave medicine, or close their practices, patients will have nowhere to go, regardless of insurance.
If government forces hospitals to take government-insured patients at a loss, they will not be able to make up those losses by charging private insurance plans, since those plans will be competing with government plans, and will have to drop their fees. This will put the most stressed hospitals out of business. Those are the hospitals that provide to the "underserved". When they go out of business, lots of patients will have insurance but nowhere to go. That doesn't help anyone. It is the opposite of what the politicians are trying to accomplish.
Americans need to wake up to what they are able to afford. You can't force private providers to give care at a loss without driving them out of healthcare, or pushing them into areas where they can avoid onerous government plans. The system will probably end up expanding public clinics for the poor. There is nothing wrong with this, and might be the best option. But we should not put countless hospitals and doctors out of business getting from here to there. We should start with that option, figure out how much it will cost, and pay for it in a straightforward and reasonable way.
Is this a straw man? How many States already have a public plan to provide insurance to those health insurers won't insure? 34 States so apparently these plans already exist. Secondly, how many employers truly provide employee health plan choice when so many of them are self insured. These are just examples of all the double speak that goes on during health care reform debate.
My 80,000+ a year family home business will benefit the best by voting for the best candidate and that candidate is Obama. We admire his courage, conviction, love and motivation as well as his youth and fresh perspective. He is the change this country needs. We are looking at history in the making with this man and we believe he will deliver, but as with any innovator, there comes a big price and we worry and hope that history is not repeating itself like it did with president Kennedy. Our family wishes him strength and hope as he takes on the challenge of trying to fix such a corrupt country.