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Proposed health care plans miss mark
Robert Reich
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TEXT OF COMMENTARY
Kai Ryssdal: Behind the closed doors of the Senate Finance Committee today... beer. Actually, raising beer taxes. Another 15 cents a six-pack, if that's of particular interest to you. Congress is trying to find ways to pay for health care reform. Exactly what kind of reform we're going to get is still in the works. There's been a lot of talk about some kind of public-private partnership. But commentator Robert Reich wonders whether there's been too much talk.
ROBERT REICH: I understand politics is the art of compromise, but at the rate we're going with health care, politicians may be giving away the store.
Right now, private insurers spend big bucks marketing policies to healthier and younger people while avoiding sicker and older people, rejecting those with pre-existing conditions, and contesting many claims.
That's why many experts have long advocated a so-called "single-payer" system that would instead focus on helping sick people and preventing others from becoming sick. And use its vast bargaining power to negotiate lower prices from drug companies and hospitals.
On the campaign trail, Barack Obama pushed a reasonable compromise -- a universal health system that included a public insurance plan resembling Medicare, which members of the public could choose if they wanted. This optional public plan could at least negotiate low prices and pressure private insurers to better serve the public.
But the Senate is taking this Medicare-like option off the table, courtesy of heavy lobbying by insurance and drug companies. And the White House is signaling it's open to other approaches.
Yet other approaches being considered by the Senate would essentially gut the public plan. One would break it into pieces run by regional third-party administrators, thereby guaranteeing that none would have much bargaining leverage to get low prices.
Another would put the public plan under state governments, further eroding it. Big pharma and big insurance already get just about whatever they want from state officials.
A third would require that a public plan adhere to private-insurance rules. But if they're rules private insurers have wangled, the public plan can't possibly push insurers to do better, or get good deals from drug companies and medical providers.
Maybe the House will come up with a real Medicare-like public option and Senate democrats will pass it under a reconciliation bill needing just 51 votes. But this won't happen unless there's huge pressure from the White House and the public.
Right now we're on the way to a universal health-care bill that politicians will claim is a big step forward when it's really, at most, a step sideways.
RYSSDAL: Robert Reich is a professor of public policy at the University of California, Berkeley.
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I have been reading the debate of healthcare for weeks, but one thing is abundantly clear: we have the best health care in the world. I never hear of someone flying off to any country that has socialized medicine for quality medical care but as a nurse of 34 years I constantly meet people who come to the US for surgery and/treatment. I always ask the person "why did you come here for care, why didn't you have this done in your country?" The answer is always the same: the care/surgery is not as good in their country and at home there are long waiting lists for non life threatening surgery. We may not have the perfect system but the world sure recognizes that we have the best.
Dr Reich's statement that a Public Healthcare System like Medicare is a necessity fails to address the fact that the people who run Medicare are inept. I retired as of 1 August 2008 and my wife and I still do not receive benefits. The reason is that we have Anthem Blue Cross as a secondary healthcare provider. The people at Medicare insisted that they should be the secondary provider until last December when they agreed to cover me as the Primary. However, they still do not cover my wife.
This would be anecdotal except that I know another couple that has had the same experience. They switched to the HMO Secure Horizons. They decided to let someone else deal with the Medicare bureaucracy.
Please understand that I have been a liberal all of my life, and until had confidence that a Public Healthcare System would be in the best interests of all Americans. That is no longer my opinion or experience.
Know also, that I have never before submitted an opinion online.
If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California
If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California
If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California
This is the time to get national health care passed. We voted to get free insurance from the government. Everybody can have medicaid or Medicare with prescriptions and the government can pay a lot less for hospitals and doctors too because they can't get pay from anybody else. Take it or leave it.
And no more higher insurance charges for people who have been sick. Make it fair!
How come it is quite alright for the greedy insurance companies to dig deeper and deeper into the pockets of the American people, all the while selling defective products?
Health insurance is not the same as health care. Insurance is for accidents.
For those who are fearful of the dirty word “socialismâ€, why are they not concerned about the fact that we the taxpayers are bailing out Wall Street and the banksters with trillions and counting, (which is corporate socialism) with no strings attached?
Obama has said that Single Payer would be the best approach if we “were starting from scratchâ€. By removing the age restrictions and expanding and improving Medicare to include all Americans, we could have a truly unique American health care system.
The same special interests that have given us the most expensive, poorest quality health care among developed countries (37th rank) are now suddenly pretending to be champions of reform. Their legislative agenda is a patent effort to stop the public demand for a meaningful universal health care system through a Single Payer- Medicare For All. The fact that over a million Americans face bankruptcy every year due to medical debt- even though the majority had insurance at the time when they got sick is ignored, as are the needs of the American people. The recent decision to close thousands of auto dealerships as part of the neo-liberal IMF/World bank austerity/structural adjustment style programs that are being shoved down our throats by the “change†Obama administration, are in effect costing the American taxpayer tens of thousands of more lost jobs, health insurance, housing, Social Security, etc. Structural Adjustment programs that have been used to impoverish developing countries throughout the world, are now being implemented here in the US, and the health care “reform†is a glaring example.
While US companies are suffering from the profit driven motives of the health insurance industry (employer-provided health insurance) , the Obama administration’s health care reform plans (mandates),will only intensify and prolong the agony for millions of Americans , as long as a Single Payer Plan is off the table. How can we allow someone like Max Baucus, (D, MT), along with others in Congress to be representing us in the current health care debate? Baucus, Chairman of the Senate Finance Committee has accepted millions of dollars from insurance companies. According to the Center for Responsive Politics, Baucus’s top funders include PACs associated with American International Group, Goldman Sachs, New York Life Insurance and Blue Cross/Blue Shield. How’s that for a conflict of interest?
. Let the American people have genuine health care security; and demand HR 676- Single Payer- Medicare for All be implemented ASAP.
As a former employee of a health insurance plan, a current HR professional (who buys health insurance and pays premiums for employees) and a lifelong individual user of health care services, here's my perspective:
1. The biggest driver of health care costs is acute management of chronic disease (CHF, diabetes, etc.). Negotiating lower rates for such episodes would be applauded by "Big Insurance" but balked at by health care deliverers who face the threat of malpractice & pressure for better health care quality.
2. The health care delivery system in the US is based upon "fee for service". Your doctor gets paid to see you, to run tests, to write prescriptions. Your local hospital only gets paid when you show up in their ER having a heart attack, not when you are sitting in your yoga class. These systems make very little money on wellness, disease prevention, and early detection. When was the last time your doctor was paid for curing you? A WHO study found that in the US a $1.00 investment in physical activity would reduce medical expenses by $3.20. But even this approach would lead to some unwelcome change for the delivery system with empty hospital beds, idle surgical units, and unemployed physicians.
3. Under the single-payer model, is the government prepared to deny health care services based on medical necessity? I want that MRI, I need that $500 per month prescription that somebody told me "to ask my doctor" about. My doctor receives no incentive to deny me, and I demand that my insurer pay for it. Yet my insurer passes this cost on to my employer through increased premiums, and my employer passes that increase on to me. I pay in the end.
4. "Big Insurance" does not always get what they want from State officials. The NY State Deficit Reduction Plan recently imposed a large tax increase onto health insurance plans covering NY State residents (funds collected to reduce the deficit, not to improve healthcare). Guess who has to pay the tax? The health insurance plan passed it on to employers, some of whom have passed it on to their employees. In this economy, some employers will simply drop their health insurance altogether, creating many more uninsured NY state residents, who can then “opt in†to the single-payer system.
Health care reform in America is overdue, but the solution does not lie with the government. As a consumer with a family, I have been thoroughly frustrated by health insurance companies all too happy to take premiums while putting up barriers to payment to hospitals, doctors and other providers. As a physician, these same companies refuse to pay for, deeply discount, or significantly delay payment for work already performed and deemed necessary by common practice of medicine. I have staffed private and faith based not-for-profits, University hospitals, County based hospitals, and VA hospitals. The shareholders and administrators of health insurance companies have financial interests opposed to those of the subscribers. But----The US government does a far worse job. Medicare is unsustainable. If a primary care physician were to recieve all of his/her payment from medicare/medicaid but had no alternative sources of income and were to have to jump through the hoops set up by these ineffidient agencies, were to pay competitive wages and benefits to employees, pay rent, utilities, and supply costs, there would be nothing left for professional salaries. The VA system, while having some excellent and hardworking staff, in its current form is mostly a jobs program which does a poor job of providing for those who served this country. A single payer system would have no reason to respond to needs in an efficient manner; there would be no competition or reason to be efficient or responsive. Health care reform in America will be complex and expensive and will have to require sacrifices of many if it is going to work. Personal responsibility will go a long way. Gluttony, sloth, ego(vanity), and lust have contributed to many of our health woes. Who gets a discount for caring for themselves? Does one pay extra for being lazy and irresponsible? How do one legislate bad behavior? Stay tuned.
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