Healthcare Reform – Why a public plan Option?

April 25, 2009

Some things I don’t understand!

I just don’t quite get the “public plan option” idea.

I read Jacob Hacker’s proposal for a public plan option again.  Professor Hacker is a scholar with his heart in the right place, a rare combination.  He gained my immense respect after I heard him speak about his book, The Great Risk Shift, a couple of years ago.

Professor Hacker makes a compelling case that a public plan is not only administratively more efficient than private plans, but that they have a convincing record of introducing large scale quality initiatives and payment reforms into the marketplace.

He then goes on to describe the dismal record of private insurers in comparison to public plans.

So why are the private plans an option if the public plans are superior?

That’s what I don’t get! Read the rest of this entry »


The COBRA Maze

April 18, 2009

Today, April 18, 2009, is COBRA Subsidy Notice Day -the deadline imposed by the American Recovery and Reinvestment Act to send COBRA notices to those involuntarily terminated after September 1, 2008.

Not exactly the same as Paul Revere’s ride, the event 234 years memorialized by Henry Wadsworth Longfellow’s poem and remembered in Massachusetts with Patriot’s Day.  With apologies to Hank, I offer this little ditty to memorialize the event occurring this year..

Listen my public and you shall cuss
About the COBRA part of the stimulus
Twas the eighteenth of April in twenty O nine
When out was tossed a feeble life line

Those who imagine that a “government run” health care system might mean more bureaucracy should spend some time familiarizing themselves with COBRA.

Certainly since the ARRA law was signed on February 19th and the regulations and additional “guidance” were released on March 30th, there has been ample opportunity.  Our office has been flooded with solicitations for seminars and webinars, and guidance form assorted professional organizations.

It is a sad reflection on the values of our society that an event as disruptive as job loss is compounded by the loss of health insurance.  COBRA was designed to alleviate that somewhat by permitting people to continue on their employer’s plan as long as they paid the full cost.  Very few – only those with expensive on going treatments – take advantage of it.  Read the rest of this entry »

Does Congresswoman DeGette Really Get It?

April 11, 2009

Congresswoman Diana DeGette (D-CO) is the Chief Deputy Majority Whip for the Democrats in Congress.  She is serving her seventh term representing the 1st congressional district in Colorado, succeeding Pat Schroeder  who represented that district and advocated for progressive causes for many years.

Diana DeGette (D-CO)

Diana DeGette (D-CO)

On April 7th of this year Congresswoman DeGette offered a powerful and personal critique of health care in the United States in a speech before the City Club in Denver.  

…Americans – including 800,000 Coloradans – have no health insurance and when thousands more Americans are losing their coverage every day. That means they’re less likely to get the medical care they need, more likely to develop chronic and life-threatening diseases and more likely to die prematurely, causing more than 20,000 preventable deaths in America every year.

It is unacceptable when the uninsured population includes 9 million children – 180,000 here in Colorado …

It is unacceptable when even families with health insurance struggle to keep up with skyrocketing premiums and co-pays only to have to fight their insurance companies for the coverage they thought they had.

They’re families like my sister’s-insured, middle-class family with two kids, paying monthly premiums of $1,100. And when my nephew had a skateboarding accident-a compound fracture of his wrist-what did her insurance company say? “Sorry. You didn’t get pre-approved for the emergency room service.”…

But she didn’t stop there

Americans often think we have the best health care in the world. But consider this. In terms of women’s health – compared to other countries – the United States ranks 24th. In infant mortality, we rank 29th. In life expectancy, we rank 31st. And for health outcomes overall we rank 37th – below the Dominican Republic and Costa Rica. Put simply, when it comes to health care, Americans pay so much more but get so much less.

This is not only morally unacceptable, it is financially unsustainable…

And she offered change

That’s why the new Congress and President Obama have moved swiftly to confront the most pressing short-term challenges….

Reform must reflect this fundamental truth: affordable, quality health care is not the privilege of the fortunate few, it is the right of every American.

Reform must achieve key goals: reduce costs, expand coverage to those who lack it and improve the quality of care.

Reform must preserve the values we cherish as Americans: choice – of doctors, providers and plans; strong doctor-patient relationships – free from government interference, and; accountability-to avoid profiteering and discrimination based on pre-existing conditions…

But she she fell on her face

And reform must reflect what is politically possible. There are those who favor a single-payer, government-run health care system. But let’s be clear: such an approach has neither public nor political support at this time despite that, we must not lose sight of our goal of providing health care for every American.

Guided by these principles, I believe a reformed system should have three essential pillars. It must cover every American; it must be affordable; and it must be portable.

For starters, she is wrong that that a single-payer system has no public support.  Polls consistently demonstrate broad support for a single-payer system.  Recently a CBS poll found that 59% of americans support a national health insurance program and 49% of Americans  believe it should cover all of their medical problems.  Other polls show similar results.  And the single payer proposal HR 676 has more co-sponsors than any other proposal.

But maybe the reason she doesn’t get it is that she is so 1990’s.  There is little new in her critique of health care.

What has changed is the work force

The in-term now is the multi-generational work force. Older people are working longer and they are generally not interested in working full time.   It is even even clearer since last September.  Younger people are entering the workforce later.  People are leaving their jobs in mid-career to go back to school, to take care of aging and sick parents, or sometime to take care of their own children.  There are more part time employees.  There are more free lance employees.  The increase is the number of free lancers and part timers is an employer response to the high cost of health care.  Each of these groups need health care.

It is nice to argue for portability.  But how to you make portability happen when people transition in and out of employment.  Concurrent with that change is a change in income status.  A genuine “affordable” reform effort that accommodates the 21st century work force is one that assures continuous coverage regardless of employment status.  The cost of the plan to individuals must reflect their ability to pay.  Only a single payer system can accomplish that.

And then there are certain sectors that have always have been difficult to insure.  Farmers and people living in rural areas have their own unique issues that make that make “free market” solutions irrelevant.

What has changed is the competitiveness of the American economy

Most politicians give lip service to the notion that health care costs impeded the ability of American companies to compete internationally. But health care costs distort domestic competition as well.  Companies that offer inurance are a competitve disadvantage against companies that don’t.  In addition,  the cost of health insurance is a significant market entry barrier for entrepreneurs considering a new idea to take to the marketplace.  If we want to encourage innovation and competitiveness, the cost of health insurance to employers needs to be equitable.

I do hope that Congresswoman DeGette will acknowledge the public support for a single payer system, the compelling policy argument for single payer, and take the lead in translating that into broader political support.

Do doctors walk on water?

April 4, 2009

During the 90’s I worked for the PA Health Care Cost Containment Council (PHC4), one of the first and still leading state agencies to report on the outcomes of hospital and physician care.

As we traveled around the state of Pennsylvania explaining the concept, there was always someone in the audience or the group who asked the question, “Do you mean that we should use this information to challenge our doctor?”  (Read, my doctor walks on water)

Our group health plan is trying to promote disease management and wellness within our population.  Yet we here from many members, “Don’t butt into my business.  My doctor tells me everything I need to know.”  (Read, my doctor walks on water) Read the rest of this entry »