At the risk of jumping into the hornet’s nest, I will start by linking to Bob Doherty – Are the right questions being asked about the public plan?
For liberal and conservative true-believers, the debate over a public plan has become a surrogate for the broader debate over the role of government in our health care system. If you believe that the government needs to take on more responsibility for financing and organizing health care in the United States, you want a public plan. (Many of those who favor a public plan option would like it to be the only option – like Canada – but have decided that this is the best they can get right now.) If you believe that the problem with American health care is too much government and not enough private initiative and responsibility, then you are opposed to a public plan.
Largely missing from the discussion, though, are the details of the "it" that everyone is arguing over. There is general agreement among policy wonks that the current Medicare payment structure is dysfunctional – it undervalues primary care and rewards volume instead of value. If so, then, does it make much sense to create a new public plan that takes this same flawed payment structure and add 10%?
Would there be safeguards to ensure that payment rates under the public plan are competitive with private insurance and high enough to ensure sufficient participation by physicians and other "providers"? Or would it end up looking more like Medicaid, where low levels of payment have resulted in low levels of physician participation and generally, poor access to care?
Medicare also does not cover most preventive services. Does it make sense then to replicate this same benefit structure in a new public plan?
One could imagine a public plan that is better than Medicare. It would pay primary care doctors more, create incentives for value, rather than volume, and cover preventive services that largely are left out of Medicare. It would pay enough to ensure sufficient participation by physicians. It would compete with qualified private insurers, but on a fair playing field.
As Bob suggests (and I agree 100%), your perception of a public plan depends on how you interpret the phrase and your political economic belief structure.
I could construct a public plan that I would support strongly, and a public plan that I would vote against.
Why might I favor a public plan? If that plan actually forced the private insurers to compete, the public plan might encourage insurance plan transparency. Have you ever tried to understand health insurance? Comparing apples and oranges is simple compared to health insurance.
We need transparency and simplification. If a public plan yielded that goal I would be happy. Such a movement could lead to decreased administrative costs for physicians, and less hassle for patients.
If a public plan requires physician involvement, and provides inadequate coverage, then I do not believe we should be excited.
A public plan is not necessarily a bad idea; as always the devil is in the details. We should debate and try to influence the details before we decide that we like or dislike the concept. Too many pundits have already set their opinions in concrete without knowing those details. And you wonder why physicians dislike politics.
{ 4 comments… read them below or add one }
Will private insurance plans have access to the same taxpayer-provided funds which the public option will receive? If not, the public option will be in an unfair position. There will be no “competition” as long as the government is the unfair player.
“Will the public option compete on its own merits, or will it compete with taxpayer money backing it?”
That is the ultimate question. If the public option does not compete on its own merits, then private insurance plans will start failing, which will inevitably culminate to the government as the only option for healthcare.
The single-payor system.
When the government can not afford to pay for the subsidies (as it already can not afford with Medicare), it will not matter whether it pays 110% of Medicare or 300% of Medicare. Payment rates will be slashed, and there will be nowhere else to turn.
why does it have to be either/or? Why can’t we have a public plan (assuming we change some of the dysfunctional parts of the current public plans) that provides the basics for everyone, and private insurers who cover what the public plan does not? Of course this option would tier health care, but health care is already tiered. For example, using the comparative effectiveness model, the public plan might cover aggressive medical therapy for patients with stable coronary disease (since COURAGE and BARI 2D shows there is no real benefit for angioplasty or CABG), but patients who were inclined to get these procedures could do so with their private insurance.
What follows are believed to be facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled desperately due to the inadequate health care they receive and access:
The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.
However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses.
Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago. Most is spent with medical institutions, as far as health expenditures are concerned.
One third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.
We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.
Our children.
Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.
About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported.
Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported, which should be addressed as well.
Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system.
The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA, according to others.
Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.
Health Care must be the priority immediately by the new administration and congress. Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S.
Likely, hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system. Health policy analysts should not be greatly concerned on the health care corporate shareholders who may be affected by this reform of our health care system that is desperately needed.
It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. This specialty makes possibly less than 100 thousand dollars annually in income, compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system.
The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.
Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system. Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers.
These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.
Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today. Perhaps the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears.
We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially, and health care for all completely. It should and likely will be funded by a combination of payroll taxes and general tax revenue which is realistically possible. Because the following seems to be in need of repair regarding the U.S. Health Care System:
Access- citizens do not have the right or ability to make use of this system as we should.
Efficiency- this system strives on creating much waste and expense as it possibly can.
Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.
http://www.mckinsey.com/mgi/publications/US_healthcare/index.asp
Dan Abshear
We must have a public option that is operted stringently to drive down health care costs