Proposed health care plans miss mark
Congress is debating how to pay for a health care overhaul and what form a new system will take. Lawmakers are trying to find a middle ground, but commentator Robert Reich says a lot may be lost in the process.
Robert Reich (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.
Comments
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09/08/2009
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.
From Huntington Beach, CA, 06/17/2009
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.
From us, CA, 06/01/2009
If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California
From us, CA, 05/28/2009
If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California
From oak park, CA, 05/23/2009
If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com - John Mayer, California
From Kaufman, TX, 05/21/2009
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!
From Menlo park, CA, 05/21/2009
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 “socialism”, 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 scratch”. 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.
05/21/2009
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.
From Columbia, SC, 05/21/2009
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.
From Colorado Springs, CO, 05/20/2009
I forgot to add a third event that could lead us to a single payer health care system:
3) When 50% or more of the population do not have health insurance or just partial health insurance.
From COlorado Springs, CO, 05/20/2009
Dear Fellow Americans:
There are only two possible events that would lead us to a for a national single payer system in my country:
1) Total economic collapse of our country
2) A grass root effort to pass a constitution amendment for such a system.
Short of either of the above events, legalized corruption will prevent any REAL health care solutions.
Because of White house waffling, I sincerely think Obama do not have the guts or the moral conviction to take on the health care system. It is just all talk.
Good Luck.
From Portland, OR, 05/20/2009
I'm a community college student. Most of my classmates are either still under their parents' benefits (if they have any) or uninsured. I have several friends with compounding medical conditions that could be prevented or minimized if they could afford basic health care, but some of them already have enough issues that, unless something changes in the health care world, make them uninsurable. I don't know if a "single payer" program would be the answer, but I do know that things need to change.
From San Diego, CA, 05/20/2009
As a clinical nurse at a major university teaching hospital I see daily the results of an inefficient and broken health care delivery system; the needless suffering in a population that is too poor afford insurance; chronic untreated illness that leads to spiraling costs and further disability. Even the state and county programs are difficult for the people at the bottom to access; most of the time they only enter by being so ill they require emergency treatment. At the same time I see money, research, and resources being thrown at expensive new treatments that involve drugs, procedures, or products; all designed with profit in mind.
I am a member of CNA (California Nurses Association) and I am proud to say that we have become political players on the national scene. We are primary advocates of a single-payor system and we will not back down and support anything less. Though we supported Obama during his election, the lives of 47 million are now at stake, as well as the future of our economy because health care costs most certainly will derail any economic recovery unless the system is reformed and wrested from the sphere of big pharma and the insurance giants.
Thank you for the story Mr. Reich. I enjoy your style of writing that mixes clear-headed pragmatism with a touch of irony. I was dissapointed that Obama foolishly forgot to pick you for a policy post.
Sincerely,
Linda Vasconcellos RN
San Diego CA
From Sparks, MD, 05/20/2009
I want to thank you and NPR for giving single payer attention. I hope you will continue to do so.
I am a physician who left practice to work fulltime for a national health system based on single payer financing.
Like many of my colleagues, I became fed up with private insurers telling me how to practice and refusing to pay for care.
A national health system will allow patients to choose their doctor without restrictions. It will allow patients and doctors to make medical decisions. It will allow transparency and public accountability. And it will save money.
A national health system will reduce health disparities and preventable deaths,remove financial barriers to health care, improve health outcomes and end bankruptcy due to medical debt.
I dream of the day we have a national health system. Then I will return to practice. Until then I will continue educating about and advocating for a national health system and will even risk arrest.
I hope my colleagues will recognize our professional responsiblity to advocate for our patients' best interests: a national health system based on single payer. Everybody in and nobody out.
From Sanford, NC, 05/20/2009
Japan and the European Union, the economic entities most like the U.S. have single payer health care. Europe has a number of variations on the basic single payer scheme.
Americans presently pay more than anyone else per capita for health care. Health insurance is not cost effective because insurance companies are incentivized to raise benefits to healthy payers while raising barriers to unhealthy ones. This maximizes insurance company profits while leaving 50 million uninsured Americans the option of getting health care at the emergency room.
Single payer would cut costs by eliminating unnecessary middle men. Insurance companies typically take over 30% overhead on every health care dollar.
Insurance companies could still process claims as government contractors like they do for Medicare and Medicaid.
From Minneapolis, MN, 05/20/2009
Reich is right. Insurance companies are trying desperately to divert attention from a single payer system and toward a system that forces all of us to continue spending 24%+ percent of our health care dollars on them and their profits rather than our health. As a former Fortune 50 company executive, and now a two-time entrepreneur, and mom in a family of four, I am convinced America's global competitiveness depends on us getting health care reform done right and done now. The lowest cost/most business, family and health favorable approaches in the industrialized world are Single Payer. We need to get on with picking from the best examples around the world and implementing our own appropriate American approach. In order to do this, we need to send strong and frequent messages to our elected representatives when we see them being bought off by the insurance companies with campaign contributions and lobbying efforts. Please send a message to your Representatives and to Max Baucus and demand that strong Single Payer advocates be given a seat at the table.
From Brooklyn, NY, 05/20/2009
Thank you for being one of few media outlets that has talked about the "single payer plan." For those of you who don't know much about this plan I suggest you visit the Physicians for a National Healthcare Plan site (pnhp.org) to get more of the details. I think it would make life better for everyone and we would save the money that is now spent on profit and on huge amounts of book keeping.
From Ann Arbor, MI, 05/20/2009
Dr. Reich makes a couple intesesting points, but he doesn't supply certain information that is totally unheard in the discussion.
1) Do "single payer"supporters understand that such a program would be bigger, by far, than the WW II mobilization?
2) Someone please explain how "universal" coverage is handled in countries of populations closest to that of the United States. That would be China, India, Indonesia and Brazil.
3) Do people really believe that claims would, or even should, be paid without first being checked over by claims examiners?
Finally, if Reich thinks that single-payer automatically means no arguments over coverage for services, I'd be happy to send him copies of some of my Medicare EOB (Expalnation of Benefits) forms.
From Los Angeles, CA, 05/20/2009
I wholeheartedly agree. I was appalled when the health care companies were applauded for promising to cut costs by what sounds like a lot, but really amounts to one less gold back scrubber, and which will most likely come from denying claims. We need to decide if what we want is health insurance or health care - these are two different things.
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