As I wrote yesterday – a public plan could be good or bad. The AMA is not waiting for the details.
The main reason that I am interested is because I do not believe our current health insurance system benefits patient care. We do not really have a free market. Karl Rove does not understand this – How to Stop Socialized Health Care – WSJ.com
He writes:
The first is it’s unnecessary. Advocates say a government-run insurance program is needed to provide competition for private health insurance. But 1,300 companies sell health insurance plans. That’s competition enough.
The problem is that patients usually do not participate in the free market – employers do. They make their decisions on a cost basis rather than a benefit basis. No one can really compare plans.
My answer is that we need insurance transparency – make it easy to compare plans. Why should the private plans not trump the public plan? They should develop leaner bureaucracy than the government has.
I do agree with the AMA on this issue:
Under a proposal favored by many Democrats, doctors who take Medicare patients would also have to participate in the new public plan. Democrats say that requirement is needed to make sure the public plan can go into business right away with a large network of doctors.
The medical association said it “cannot support any plan design that mandates physician participation.” For one thing, it said, “many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.”
“In addition,” the A.M.A. said, “federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis.”
If the Democrats insist on participation, then I will vocally oppose the plan. I see a public plan as increasing competition and putting pressure on private insurers. Thus, I want a level playing field.
{ 5 comments… read them below or add one }
“My answer is that we need insurance transparency – make it easy to compare plans.”
That is why the tax benefit and subsidies of employer-provided health insurance needs to be abolished. It is absurd that an individual must be employed in order to obtain health insurance at a reasonable rate.
The goal should be to remove the employer-based health insurance tax benefits to encourage greater participation in the individual health insurance market. This is competition: insurance companies vying for the attention of individuals in the individual insurance free market. Faux competition through a taxpayer supported public option, especially when private insurance will not receive the same taxpayer dollars as the public option, is intellectually dishonest and the wrong way to go.
Currently with or without participation in Medicare, fees are limited to participating and nonparticpating rates. Under straight Medicare, I have the right to turn away any patient I don’t want to see. Under most of my HMO contracts I am supposed to accept new patients, until I reach a certain number or until I stop seeing patients from all contracts. Obviously, most physicians do not necessarily honor these contracts.
The worst commencial HMO contract pays me less than $40 for an office visit, which means those patients do not get weekend or evening hour appointments. Those patients also may have do wait longer for appointments, compared to my best contracts that pay $70 for the exact same level of care. There are ways to limit patients, unless the public plan is capitated and the patients are assigned to individual doctors. At least 90% of the local doctors accept Medicaid, but only a university residency is accepting new Medicaid patients.
My point is that if the new public plan pays fair fees, then it should go over well with doctors, regardless of what the AMA says. If not, doctors will find a way to limit or all together not accept patients from this new public health plan.
I agree with AMA position although they will be accused of an obvious conflict of interest The mandatory participation in the public option is an example – with many more to follow – of the stranglehold the government will have over the medical profession and the health care system. Employers and individuals will also be mandated to purchase insurance or pay a fine. Democrats and other public option proponents are mum when it comes to assessing the costs of their ‘reforms’ and who will pay the bill. Shouldn’t we know what something costs and who will pay for it before we buy it? http://www.MDWhistleblower.blogspot.com
The public vs. private plan is the wrong debate. Either can be done well or done badly. At the present, we have both which are mostly done badly. A public plan could be done well if it took some lessons from the VA. At the present time, it doesn’t look like the democrats are proposing much more than an expansion of Medicare or Medicaid. If this is the case, then like DB, I would be against their plan. On the other hand, the Repbulicans also aren’t proposing any kind of fix other than more of the same on the private side. There are also examples of how the private side could be better – Mayo in Minnesota, Geisinger in PA, etc. The debate should be on what needs to change to lower costs & increase quality. This rests on public health measures and expanding access to primary care. The medical system needs to (and can) cost much less, not more.
Peter,
The public option is not taxpayer-funded. Like any other insurance company it will have to support itself on its own premiums. The difference is that it will be a nonprofit organization with modest executive compensation, as opposed to the private companies. If this results in cheaper health care, then competition will drive down the prices of the private companies. If it does not result in cheaper health care, then it will not have an effect on the market. In either case, this is a market-based solution, and not a government takeover, as you’ve implied.